NSW Doctors Orchestra :: Registration form

Instrument *
Preference (1st/2nd if applicable)
Surname *
First Name *
Email *
Mobile Phone Number *
Alternative telephone contact number
Postal Address *
Postcode *
Is this your first time playing with us?
Are you a student? *
Field of Medicine *
Which medical school did you graduate from? *
Suburb where you reside *
Suburb(s) where you work *
Hospital Affiliations
University Affiliations
Would you agree to feature in a media story about the orchestra/our next performance? *	Yes No
Do you have an interesting feature/story about you or your music making that we might use for publicity?

PAYMENT INTO ACCOUNT:

NSW DOCTORS ORCHESTRA

BSB 062229 ACCOUNT NUMBER 10096885

DOCTORS $300 / STUDENTS $125

PLEASE INCLUDE NAME WITH DEPOSIT

REGISTRATION CLOSES 11 March 2018