MMT Application Form

Personal Details
Name: *

First Last
We need you to submit a photograph of yourself for our records. Please select how you will supply one to us. iPad/iPhone users please select "Upload one" then chick choose and Take Photo option will appear.

Upload one Take one now with you computer camera
Please upload a current photo here:
Take Your Photo

Address

Landline Phone:

- Area Code Phone Number
Mobile Phone: *

- Area Code Phone Number
Email: *
Date of Birth: *

- Month - Day Year
Gender *
Please note if you are under 18 you will need to print out the parental permission form and have it signed by your parent/guardian. Please send the form by post, we won't process your booking until we have recieved this.
Next of Kin information
Name
Relationship
Land Line
Mobile
Do you suffer from any medical conditions, physical or otherwise that could impact on your full participation throughout the week?

Yes No
Yes, give details
Do you require a special Diet e.g Vegetarian, Coeliac, Allergy?

Yes No
Yes, give details

Participation
We would like to involve as many people in the music sessions and liturgies. Please indicate below if you wish to assist.
Do you play a musical instrument/sing solo (Cantor)?

Yes No
If yes, give details
How did you hear about the course *

Deadline for application is August 1, 2017

Please note that once accpeted into the course, registration fees are non-refundable.

Registration costs €300 (inludes all materials, food and accomodation)
We will be taking photos and video footage during the course. These photos/ videos will be used for course related promotional materials in print, video and online. If you do not want your image or the image of your child to be used please indicate by selecting NO. *

Yes No
Payment due is
Participants have the following payment options for completing this application: *

I will pay by Credit Card using PayPal. My tuition is being paid for by my parish/school.** I will pay when I arrive (surcharge of (€20)
**If your tuition is being paid by your parish or school you must provide the name, address, phone number, and contact person here. *
Total Course Cost
Payment Due Now

EUR Course Fees
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Should be Empty:

Attendance Details