Floot Fire Plano 2012 Registration

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Any labels in bold red mark required fields. Your registration will not be processed without entering at least those fields.

Personal Data

Names Student First Name

Student Last Name

Guardian First Name

Guardian Last Name

Home Address Address (1st line)

Address (2nd line)

City

State

ZIP

Telephone & Email Telephones
Primary (1st choice)

Secondary (2nd choice)

Tertiary (3rd choice)

Email Addresses
Primary (1st choice)

Secondary (2nd choice)

Education last School Grade completed

Flute Teacher

(if Teacher not listed) First Name

Last Name

Telephone #

Email

Years of Study

Accomplishments Sightreading Skill

Playing Level
(determines Electives for which
you are eligible)

Honors

Recently Performed Solos

Plano Registration

Location Custer Road United Methodist Church
6601 Custer Road
Plano, TX 75023

Camp beginsCamp Ends
Monday, June 13, 2011 - Saturday, June 18, 2011

Late Registration begins
Monday, June 6, 2011

If you have chosen Floot Fire Plano,
please download both the
Welcome Letter and Medical Release Form.
Please remember to
have your Medical Release Form notarized
before camp registration.

Tuitions & Fees

Full Tuition	+	295.00
1/2 Day Tuition (Floot Flicker only)	+	150.00
Late Registration (as of 2011-06-06)	+	10.00
Pre-approved need based scholarship amount
Number of students you wish to host (contact Ellen Kaner for hosting details 817.691.7198 or ekaner@aol.com)
Solo Competition (Optional)
Entering Solo Competition?	+	40.00
I understand the Solo Competition will be held June 15 at the Floot Fire Plano location
I understand the Solo Competition Requirements Solo Competition Details
I understand my flute teacher must recommend me for Solo Competition Teacher Recommendation Form
Solo Piece Title
Solo Piece Composer
Solo Piece Length (how many minutes)
Require Accompanist for your Solo?	+	40.00

Electives

Memorabilia Youth T-shirt (S)
Youth T-shirt (M)
Youth T-shirt (L)
T-shirt (L)
T-shirt (M)
T-shirt (S)
T-shirt (XL)
T-shirt (XS)
T-shirt (XXL)
no T-shirt ( )
DVD of Solo Competition Final ($20.00)
DVD of Plano Teacher Recitals ($20.00)
DVD of Final Flootfire Concert ($20.00)
'serious' photo ($10.00)
'crazy' photo ($10.00)

Payment

For non-Paypal, mail payment to:

Floot Fire
c/o Larry Bailey
2553 Primrose Dr.
Richardson, TX 75082

Your Floot Fire Plano 2012
purchase selections are listed below

To pay via Paypal

Paypal adds 2.9% + .30
transaction fee

Floot Fire thanks our generous sponsors
Miyazawa Flutes
Carolyn Nussbaum Music Company

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