Register to

First Name:                                           Last Name:                                                    

Age:

Street Address:                                     City:

State:                                                    Zip Code:

Cell Phone:                                           Home Phone:

Email Address:

Instruments interested in: (Check all that apply)  

Snare                   Mallets

Tenors                Auxiliary Percussion

Bass Drum          Electric Bass     

Cymbals              Electric Guitar

Drum Set             Keyboard (Synthesizer)

Previous Experience (Please tell us what, where, and for how long):

Why do you want to be a member of Insight Percussion Theater (Feel free to elaborate):

Please contact me by: Email Telephone