Registration for Virtual Bucket Drumming 101- 6 week Series
Thank you for registering to participate in the six-week program. This program is sponsored by Culture Blocks— a community partnership funded by Mecklenburg County.

Questions on this form are to collect information in order to provide a report to the Arts & Science Council on enrollment numbers and assist the facilitator, Ms. Ashley, Tisdale, MT-BC with tailoring the program and Ms. Matrisha Stafford, MT Intern.

Limited materials are available (14 kits as of November 9, 2021). After submitting this form you will receive an email with details for picking up your instrument/materials kit and links to the six recorded classes to view on a personal device.

If you need assistance with this registration form, please call 803-206-2044 (no text messages possible) or email director@piedmontmusictherapy.com.
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Email *
Do we have permission to subscribe your email address to PMT Newsletters? *
Registrant's First Name *
Registrant's Age (this is geared for children ages 8-14) *
Phone Number *
How did you learn about this event? *
If "Other" please describe how you learned about Culture Blocks:
Which location is closest to your home for picking up your free material kit? *
What is your zip code in Charlotte? *
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