Çudamani Gamelan & Dance Summer Institute
Bali, Indonesia 2009
Three week program: June 28-July 19
Application deadline: February 7, 2009 or until enrollment fulfilled
I am applying for:
3 weeks June 28-July 19
Last Name
(Family Name)
Middle Name
First Name
(Given Name)
Address
City
State
Zip
Country
Business Phone
Home Phone
Fax
Email
Date of birth (month/day/year)
Gender
Male
Female
Country of Citizenship
US
Other
,
Specify
Is English your native language?
Yes
No,
Specify
Occupation
Areas of specialty/ interest
Music
Dance
Will you be accompanied by your children?
Yes
No, If so how many and what ages
Please summarize your statement of interest below in 250 words or less. Include your reasons for wanting to participate in this program. Mention experience you have in Gamelan music, dance and/or other performing arts background.
References:
Individual who can comment on your experience and training in music and/or dance.
Name
Title and Affiliation
Address
Telephone/Fax
I am paying via
Credit Card (PayPal)
Personal Check
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