Louisiana Association for Jazz Education
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LOUISIANA MUSIC EDUCATORS ASSOCIATION
ALL-STATE JAZZ ENSEMBLE
REGISTRATION FORM 2011-2012
Name______________________________________________________________________________________________
PRINT!!!!! Last First Middle
Instrument______________________________ T-Shirt Size_________ Present Grade_____
Home Mailing Address ______________________________________________________________________________
(City-State)____________________________________________________________ (Zip Code)__________
Home Phone ( )_________________
Cell Phone ( )_________________
Personal Email ___________________________
School __________________________________
Director (Print)__________________________________________________
Director Signature ___________________________________________
Director must attach a photocopy of LMEA/MENC Membership Card.
School Address___________________________________________________
(City – State)___________________________________(Zip Code)________
Band Email _____________________________________________________
School Phone ( )______________HOME ___________
LMEA District ____________________________________ La. Parish_______________
Mail This Form to: Andy Pizzo
LMEA Jazz Chairman
Sherwood Middle Academic Magnet School
1020 Marlbrook Drive
Baton Rouge, LA 70815
THIS FORM MUST BE RETURNED WITH $12 FEE BY SEPTEMBER 16, 2011