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DURHAM MEDICAL ORCHESTRA PROSPECTIVE MEMBER FORM
Please make sure you complete the form below before your audition. If you have any questions or concerns please email us at:
director@dmomusic.org
or
personnel@dmomusic.org
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FIRST NAME
*
Your answer
LAST NAME
*
Your answer
INSTRUMENT
*
Your answer
SECONDARY INSTRUMENT (if applicable)
Your answer
EMAIL (will be used for weekly communication)
*
Your answer
PHONE NUMBER
*
Your answer
ALTERNATE PHONE NUMBER
Your answer
MAILING ADDRESS
*
Your answer
DESCRIBE YOUR MUSICAL BACKGROUND
*
Your answer
CONNECTION WITH MEDICINE (for example but not limited to: doctor, nurse, researcher, medical or graduate student, current or former medical system employee, someone with an interest in music/ healing, or family member of any of these):
*
Your answer
ANYTHING ELSE YOU WOULD LIKE TO SHARE?
Your answer
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