SCHOOL REGISTRATION FORM

Thank you for registering for the 2022/23 Link Up Program: The Orchestra Moves. If you have questions or need assistance filling out this form, please contact: Katy Vizdal, Education & Community Engagement Director, katy.vizdal@eugenesymphony.org, 541-687-9487 x1116.

Program Details available on the Eugene Symphony website, HERE.

Question Title

* 1. School Name

Question Title

* 2. District Number (eg. Eugene-4J, Springfield-19, Bethel-52)

Question Title

* 3. Is your school Title I?

Question Title

* 4. Please select the category below that best describes your school:

Question Title

* 5. Primary Contact Name

Question Title

* 6. Contact Position

Question Title

* 7. Contact E-mail Address

Question Title

* 8. Contact Phone Number

Question Title

* 9. Billing Contact Information, if different than above

Question Title

* 10. School Mailing Address

Question Title

* 11. City

Question Title

* 12. Zip Code

Question Title

* 13. Grades participating in Link Up (Designed for Grades 3-5; with flexibility)

Question Title

* 14. Select which professional development workshop you will attend:
(Attendance required)

Question Title

* 15. Do you want a physical copy of the Link Up: The Orchestra Moves Teachers Guide?

Question Title

* 16. YOUTH CONCERT: Select which culminating Link Up Youth Concert your school will attend:

Question Title

* 17. # of Students participating at your school

Question Title

* 18. Estimated number of chaperones (including teachers) attending Youth Concert

Question Title

* 19. Number of scholarships requested for Youth Concert (students only)

Question Title

* 20. Estimated number of buses for Youth Concert

Question Title

* 21. Please share any special seating accommodations we can provide here: (i.e. Wheelchair accessibility, preferred seating area in the Silva Hall, etc.)

Question Title

* 22. SPECIAL OPPORTUNITY: Eugene Symphony composer-in-residence Angélica Negrón is available to visit 2-3 local elementary schools participating in Link Up: The Orchestra Moves, which features Negrón’s composition, Un, dos, tres. Are you interested in having Angélica Negrón visit your school the week of February 13, 2023?

Question Title

* 23. How did you hear about this program?

Question Title

* 24. Please list additional questions or comments you have here:

T