Application

45th Zenon Brzewski International Music Courses in Łańcut
– application form

Before completing, the form please get acquinted with all the information on the www.kursymuzyczne.pl. Applications can be sent in from 1st. March 2019 to 20th June 2019.

Family name:


First Name:


Date of birth:


Sex:
MaleFemale

Address:

Address:


Country:


State / Province / Region:


City / Town:


Zip / Postal Code:

e-mail:


Phone number:

I choose:
Session One 1-13 July 2019Session Two 15-27 July 2019Session One and Two 1-27 July 2019

I come as:

Instrument:

I wish to study with prof.:

Music training so far (say how long you have studied and where):

Specify two or three pieces you want to study with your course tutor:

I also wish to do:
aural trainingchamber musicstring orchestra

Surname and name of the parent or legal guardian (when an applicant is underage):

My choice of accommodation:
SEZAM Hotel with full boardroom in a Łańcut resident’s homeI will make my own room and meals arrangements

Please note that course members and their guardians should arrange their own health and accident insurance.

I declare that I have read the information on the website www.kursymuzyczne.pl and accept the terms stated.

I declare that my guardian and I have taken out health and accident insurance.

I agree to the storage and processing of my personal data contained in the application for the needs of recruitment and documentation of the course (Personal Data Protection Act of 20.08.1997)