COLLEGIUM MUSICUM SCHLOSS POMMERSFELDEN

Secretary office: Gartenweg 7, A - 8046 Stattegg - TEL./Fax: +43/316/694877

Mobil: +43/676/3226764
The International Summer-Academy 2016 from 16th of July until 16th of August
email: nyari@collegium-musicum.info
www.collegium-musicum.info

APPLICATION
name ............................................... first name............................................... Male / Female
date of birth.........................................
nationality ...............................................
address .............................................................................................. (street)
address .............................................................................................. (City)
address .............................................................................................. (Postcode)
address .............................................................................................. (Country)
telephone/e-mail .............................................
instrument/secondary instrument ..................................................................
vegetarian Yes / No
Health insurance No.: .......................................................................................................................
(It is necessary!!!)
Insurance company .......................................................................................................
Instrument insurance No.: .............................................................................................
Insurance company .......................................................................................................
(The sum insured for wind instruments and accessories is 1.500,-- , for string instruments and
accessories 2.500,-- .)This is a service by Collegium-Musicum.
MUSICAL STUDYS
College/ Academy / conservatory ............................................... ...............................................
...............................................
matriculated since ............................................... term no. .............................................
teacher..............................................
PROFESSIONAL EXPERIENCE
................................
...................................
............................
................................
........................................
............................
................................
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Side 2-

Name:.............................................................

TUITION, BOARD AND LODGE ARE FREE OF CHARGE.

ALL THE STUDENTS WILL GET A POCKET-MONEY-SCHOLARSHIP.
In addition to your application please remit as a deposit 50,-- to the following bank account:
Raiffeisenbank Ebrachgrund, Account No. 100 126 225 Collegium Musicum,
BLZ 770 690 91, IBAN: DE 90 7706 90910100126225, BIC:GENODEF1SFD
All transfer-fees must be paid by the applicant. Application-tax will be fully refunded at the last
day of the academy.
I oblige myself herewith to permanent and active participation throughout the whole course.

date ...................signature ..............................................

CURRICULUM VITAE

Opinion of a Teacher/Director or conductor: