RPTG Recital Form (to be completed by teachers only) Saturday, March 19th @ 1:30pm or 2:30pm

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Rochester Academy of Medicine
1441 East Avenue
Rochester, NY 14610

Please mail $5 payment per student (checks made out to RPTG, Inc.) to:
Beth Fischer
333 Ayrault Road
Fairport, NY 14450

Electronic payments will also be accepted via PayPal (must select GOODS AND SERVICES)
@rptguild
rptgtreasurer@gmail.com
https://www.paypal.com/paypalme/my/profile
PayPal charges us a .65 fee per transaction, so the recital fee for electronic payments is $5.65.

Email *

QR Code for PayPal payments - scan for a direct link

Which recital is this student performing in? *

2:30 High School Senior Recital

Student Name and Age *

Name of High School Attending *

Student or Family email address *

Student Level *

Early Elementary

Elementary

Late Elementary

Early Intermediate

Intermediate

Late Intermediate

Early Advanced

Advanced

Teacher Name and Phone Number *

Piece 1 Title (include movement(s), Op., BWV, K., etc.) *

Composer (Include first initial) *

Time *

Piece 2 Title (include movement(s), Op., BWV, K., etc.)

Composer (Include first initial)

Time

Piece 3 Title (include movement(s), Op., BWV, K., etc.)

Composer (Include first initial)

Time

Will this student require any special accommodations or equipment such as a footstool, raised bench, pedal extender, or music stand? Please specify, otherwise you may leave this question blank.

Thank you!

Send me a copy of my responses.

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