CAMBRIDGESHIRE MUSIC ACADEMIES
MEMBERSHIP FORM 2012/2013
(please complete in capital letters)
First Name: Surname:
Date of Birth: E-mail:
School / College / University: School year:
Instrument(s), Current Grade and Current Teacher if learning:
Ensemble experience: Are you a member of any other local or national ensembles or music groups?
(NYO, Holiday Orchestra, etc.)
Do you have any dietary requirements?
Do you have any existing medical conditions?
Please provide further information regarding medical conditions that may be relevant e.g. Allergies, Asthma,
Contact Details (Parent/Guardian)
Parents/carers full name:
Home Phone: Mobile Phone:
Payment information: We are migrating customer accounts to our new online systems and will contact
you with further information when this is ready. Until then we will invoice you for each term of
membership, depending on the ensembles you select below. Our charges are detailed on our website
Would you be interested in helping out at events / performances (stewarding, backstage, pastoral)?
(please delete as appropriate)
YES / NO
If registering for Fenland and East Cambridgeshire Area Academy would you require transport? Please
state your pick up point from the list provided on our website.
Your Music Academy
Which Academies and groups would you like to join? (please tick)
Fenland and East Cambridgeshire Area Academy whole centre
Cambridge [Anglia Ruskin University] Area Academy
Cambridge [Chesterton] Area Academy
Cambridge [Milton Road] Area Academy
Which band/ensembles are you intending to join – please see the list of ensembles available in the
academy information? If you are unsure then please just come along and we will help you identify the
right bands for your level.
Cambridgeshire Music likes to ensure that its groups and events are promoted widely. To do so requires developing press
and publicity information to be used on posters, leaflets and marketing materials. Images may also be used on the
Cambridgeshire Music website and social media related pages. Occasionally, Cambridgeshire Music staff or local
photographers will be asked to take photographs of music-making. Please indicate your agreement with the following that
photographs may be taken by ordinary camera, digital camera or video camera. Please be assured that your child’s name
will never appear along with an image without further permission. Please note that the copyright of photographs belongs to
I agree / I do not agree to give photo consent for my child (please delete as appropriate)
I agree to accept the terms and conditions of membership as communicated to me and set out on the
Cambridgeshire Music website and the expectations of being a member of Cambridgeshire Music Academies. I
agree to pay the charges as advised for my child’s membership.
Please return this form as soon as possible to Cambridgeshire Music,
The Old School, Ermine Street North, Papworth Everard, Cambridgeshire, CB23 3RH
or email firstname.lastname@example.org