Name (to appear on name tag):_______________________________________________
Academic Affiliation:________________________________ Faculty [ ] Student [ ]
Mailing Address:__________________________________________________________
City/State/Zip:____________________________________________________________
Is this a change of address? NO [ ] YES [ ]
Telephone: (w)__________________________ (h)___________________________
E-mail address:___________________________________________________________
Registration Fee. . . . . . . . . . . . . . . . . . . . . $____________
Before 1 May: MTMW Member $15; Non-Member $25; Student $8
After1 May:
MTMW Member $20; Non-Member $30; Student $13
Dinner Buffet (Saturday, May 20, 6:00 pm):
_________ persons @ $10.00 each . . . . . . . . . . . . $____________
I plan to attend the performance of Brahms Ein deutsches Requiem :
NO [
]
YES [
]
Number of Tickets:_____ (limit of two)
Total Amount Enclosed (Check payable to "MTMW")...$___________
Mail check along with this completed registration form to the following address. Your
canceled check will serve as your receipt. Please do not send cash:
Gene Biringer
MTMW Registration
Conservatory of Music
Lawrence University
Appleton, WI 54912