2018AmericanSaxophoneAcademyRegistrationFormI.STUDENTINFORMATION________________________________ Female Male ________________________________LastName,FirstName EmergencyContactPerson/Phone/Relationship__________________________________________________ (______)_________________________HomeAddress City/State/Zip Student’sPreferredPhone________________________________________________ (______)_________________________E-mailAddress(printclearly) DateofBirth Student’sAlternativePhone________________________________________________ (______)_________________________SummerAddress(ifdifferent) EffectiveDatesfor SummerTelephoneNumber(Cell)

SummerAddress________________________________________________ ________________________________StateofLegalResidence(ifyouareaU.S.citizen)County Instrument________________________________ ________________ Areyouapermanentresident?CountryofCitizenship(ifnotU.S.) Typeofvisa/exp.Date YES NOHaveyouattendedtheUniversityofIowabefore? YES NOIf“Yes,”lastdateofattendance:________________ Nameofwhenenrolled:____________________________________

II.EDUCATIONALHISTORY Pleasesubmitaresumeonaseparatesheet.III.PERFORMANCEINFORMATION

A. Pleaselistintheorderofproficiencyandpreferenceofsaxophone(soprano,alto,tenororbaritone)thatyouwouldliketoperforminquartetandlargeensemble.Youwillbeexpectedtoauditionontheinstrumentofyourpreferenceforthequartetassignment.1._________________________2._________________________3._________________________4._________________________

B.Whichsaxophone(s)wouldyoubeabletobring?

1._________________________ 2._________________________ 3._________________________4._________________________

______________________________________________________________________________IV.HOUSING/MEALSWORKSHEETWillyouneedhousinginaresidencehall? Yes No Ifso,pleaseindicatethedateyouplantocheckin,andthedateyouplantocheckout.Multiplythenumberofnightsincludedinyourstaybythedailychargeof$55(U.S.funds).Ifyouhaveanyspecialneeds,pleaseexplainonaseparatepage.________________________ ________________________ ___________X$55/night=_______________Check-InDate(after4p.m.) Check-OutDate(byNoon) #ofNights Total(includebelow)Doyouplantoeatmealsinauniversitycafeteriaduringyourstay? Yes No Ifso,pleasenotethatmealscost$28.50perday,andincludebreakfast($7.50),lunch($10.50),anddinner($10.50).Thedininghallsarecashless,soyouwouldneedtopurchasemealsatthecafeteriadoorusingacreditcard–Visa,Mastercard,orDiscover.TherearealsomanyexcellentdiningoptionsthatareoffcampusbutneartheASAsite.

V.REGISTRATIONINFORMATIONASATuition $760.00Housing(fromabove) $_______________

TOTAL $_______________

VI.PAYMENTINFORMATIONIMPORTANT:Dr.KennethTsemustapproveyoutoregisterbeforeyousendthecompletedformandpayment.OnceDr.TsehasapprovedyoutoregisterfortheASA,pleasemailacheckormoneyorderpayabletotheUniversityofIowato:

LisaKrause1400LVOXSchoolofMusicUniversityofIowa93EBurlingtonStIowaCity,IA52242

NOTE:Creditcardscannotbeacceptedatthistime.

VIII.PHOTOGRAPHY,SOUNDANDVIDEORECORDINGRELEASEI,_____________________________________(nameofstudent),herebyconsenttobephotographedandrecorded(soundandvideo)fortheUniversityofIowa.Theresultingphotographs,soundandvideorecordingsmaybesubsequentlyusedwithoutcompensationtomebytheUniversityofIowaorthirdpartiesforpublications(includingwebsites),advertising,and/orpublicitypurposesatthediscretionoftheSchool’sCommunicationsOffice.Iwaivetherighttoinspectorapprovethefinishedphotographand/orrecordingand/orpublicationuse.Thisreleaseformwillbekeptonfile.

____________________________________________________________________________SignatureofStudent(or,ifstudentisunder18yearsofage,signatureofparentorguardian)