Middle and High School Registration Form

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Thank you for using the online registration form for the Eugene Symphony's Middle and High School Youth Concert.

Concert Details:

Date: Tuesday, February 14, 2012

Times: 10:15 - 11:00 AM & 12:30 - 1:15 PM

Fee: $5.00 for each student and adult. No one will be denied access because of inability to pay. Please indicated below the number of students you anticipate being unable to pay.

Payment: Please pay fee within one week following the concert. Please make your checks payable to Eugene Symphony. Schools will be charged for cancellations less than two weeks prior to the concert.

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* 1. School Name

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* 2. District Number

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* 3. Contact Person

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* 4. Contact Position

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* 5. Contact E-mail Address

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* 6. School Mailing Address

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* 7. City

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* 8. Zip Code

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* 9. School Phone Number

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* 10. Grades Attending

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* 11. Concert Preference

Tuesday, February 14, 2012; 10:15 - 11:00 AM

Tuesday, February 14, 2012; 12:30 - 1:15 PM

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* 12. Number of Students Attending

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* 13. Number of Chaperones Attending

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* 14. Number of Students/Chaperones Unable to Pay

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* 15. Number of Wheelchairs

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* 16. Estimated Number of Buses

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* 17. Special Seating Needs (Other Than Wheelchairs)