Name*

Prénom Nom

Phone*

Email*

Saisissez un e-mail Confirmez l’e-mail

Address*

Adresse postale Ville Province Code postal

Instruments (please include years of playing experience)*

Person to contact in emergency (name, relationship, phone number)*

For Members under the age of 18, include: Age of Applicant, Name of Parent/Guardian, and Phone/Email/CellPhone for Parent/Guardian

Please tell us a little bit about yourself (occupation, other interests, etc.)*

I agree to my photo being posted or used for promotional purposes

How did you year about the Codiac Concert Band?

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