Application Form

Name:______________________________________________________________

(  ) Male    (  ) Female

Address:_____________________________________________________________

____________________________________________________________________

City:_________________________   State:__________    Zip Code:_____________

Country:______________________ Age:______________

Telephone: _________________________      Fax: ___________________________

Email: _______________________________________________________________

Instrument: ___________________________________   Years Studied: __________

Accomplishments:______________________________________________________

_____________________________________________________________________

Requested Teacher:_____________________________________________________

School:_______________________________________________________________

☐ Advanced Violin Studies with Michael and Irina Tseitlin

____________________________________________________________

Signature of Student (if student is 18 or over)

Date: ____________________________
 
 
 

____________________________________________________________
Signature of Parent or Guardian (If student is under 18)

Date: ____________________________
 

Please print this form, fill it out, sign where indicated above, then send it
with payment, a short audition CD or tape having 2 contrasting styles of
your choice, and a letter of recommendation to the address below:

Burgos International Music Festival
270 Washington Avenue
Pleasantville, NY 10570

- Checks are to be made payable to:
   Summit Management
 

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