"Living Your Dreams In Performing & Visual Arts"
Mentee Application
Name:
Address:
City, State, Zip:
Home Phone:
Cell Phone:
Email:
Date of Birth:
School:
Grade:
Emergency Contact Name:
Emergency Contact Relationship (Parent, Grandparent, Guardian, etc.):
Emergency Contact Home Phone:
Emergency Contact Cell Phone:
Emergency Contact Work Phone:
Additional Contact Person:
Additional Contact Phone:
Selection of Desired Dreams
Please check the box next to each of your interests.
Muzika will provide instruments for those who do not own one.
Comments:
Come and invest in your life by making Dreams Become Reality!
Please complete the above form and click submit to email to Muzika. A Muzika representative will be in contact with you as soon as possible.
Contacts
Par Tolliver
Email - par@muzikainc.org Telephone - (937)624-4294 Postal Mail - P. O. Box 1382
Springfield, OH 45501
Alyce Comer
Email - alyce@muzikainc.org Telephone - (937)605-4071 Postal Mail - P. O. Box 1382
Copyright 2007 Muzika, Inc. All rights reserved.