For DYS Board Use Only: For Conductor Use Only:

login:________________ String _______

Password: ____________ Concert _______
Dues paid: $__________ Symphony _______
Date paid: ____________ IFC _______
Notes: _______________ AFC _______
_____________________________ Notes:

Ford Community & Performing Arts Center

15801 Michigan Ave, Dearborn, MI 48126
313-943-2354, ext. 5538
www.dearbornyouthsymphony.org

PLEASE COMPLETE ONE FORM FOR EACH MUSICIAN IN YOUR FAMILY

Date____________________________Bring a Friend Night? No Yes which ensemble did you visit?

Strings Flute Concert Symphony
Musician's Name__________________________________________________________________________
Parent and/or Guardian name(s)______________________________________________________________
Address_________________________________________________________________________________
City, State____________________________________________________Zip_________________________
Parent Phone Number____________________________ Parent Email_______________________________
Musician Phone Number_________________________ Musician Email______________________________
Please circle your current DYS status: New Member Returning Member
For returning members, how many years have you been a member of DYS? _________________
The Dearborn Youth Symphony uses email and our website as our primary means of communication. This
may include information regarding concerts, auditions, cancellations, etc. We will use the above emails for this
communication. If there are others that you would like added to our distribution list, please list below:

________________________________________________________________________________________
School__________________________________________________________________________________
Grade for the 2017/2018 School Year___________ Birthdate________________ Current Age_________
Primary Instrument_________________________________ Years Played___________
Secondary Instrument(s)___________________________ Years Played___________
Do you play in any other musical groups? Please list______________________________________________
Private Instructor/Conductor's Name___________________________________________________________
How did you learn about DYS?_______________________________________________________________
Were you referred by a current musician? ________ If so, who? ___________________________________