Salutation Salutation Dr. Mr. Mrs. Miss Ms. Other

First Name

Surname

Residential Address

Mailing Address

Phone Number

Mobile Number

Email Address

Which instruments do you play? Which instruments do you play? Eb Soprano Clarinet Bb Soprano Clarinet Eb Alto Clarinet Bb Bass Clarinet Eb Contra-alto Clarinet Bb Contra-bass Clarinet Bb Soprano Saxophone Eb Alto Saxophone Bb Tenor Saxophone Eb Baritone Saxophone Bb Bass Saxophone

What is your level of experience? What is your level of experience? Primary School Student Middle School Student High School Student Tertiary Level Student Adult Hobbyist Player Professional Player

Would you like to be included on the Clasax Teachers' Register? Would you like to be included on the Clasax Teachers' Register? Yes No

Membership Type Membership Type Adult - 1 year membership - $50 Student - 1 year membership - $25 Life membership - $600