"Living Your Dreams In Performing & Visual Arts"

 
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Please complete the online application to participate in Muzika programs.

 
 

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.

Voice Choir Quartet
Pottery Theater Art
Modeling Dance Tap
Ballet Interpret/Spiritual Dance Modern Dance
Commercials Stage Hands Road Crew
Writing Piano Tuning Promotions
Management Music Teacher Piano
Keyboard Organ Pipe
Hammond B3 Baritone Sax Alto Sax
Soprano Sax Tenor Sax Clarinet
French Horn Flute Oboe
Flugel Horn Bassoon Harmonica
Trombone Tuba Trumpet
Vibes Acoustic Guitar Folk
Bass Lead/Rhythm Upright Bass
Banjo Violin Cello
Fiddle Fretless Harp
Hawaiian Acoustic Drums Electronic Drums
Band Bass Drum Band Snare Band Quad Drums
Steel Drum Congo    
Programmer/Operator:          
Keyboard Computer Audio
Video Lighting Sound Tech
Sound Engineer Photography Graphic Art
Radio Broadcasting        
           
Tutoring In School Work        
           
Do you own an instrument?          
           

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

                      Springfield, OH 45501

 

 

 
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