Registration Form – State Large Ensemble Assessment Use this form ONLY if paying by credit card. If you are paying with a school check, use the paper form.Select Type of Ensemble(Required)Select Type of EnsembleBandWind EnsembleFull OrchestraString OrchestraChoirSelect ChoirType of Ensemble(Required)Elementary, Middle School, MS Combined, HS Combined, High School, etc. Level of Ensemble(Required)Level .5, 1, 2, 3, 4, 5, 6; [spacer height="1px"]Choirs include voicing: Mixed SAB, Treble SA, etc. SCHOOL AND ENSEMBLE INFORMATION:School Name(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Name of Ensemble(Required) Number in Ensemble(Required) Lowest Grade(Required) Highest Grade(Required) DIRECTOR INFORMATION:Director's Name(Required) First Last Email(Required) Cell Phone(Required)LMEA/NAfME Number(Required) Expiration Date(Required) SELECTIONS:Performance Selections:Enter the selections in performance order.Selection #3 is optional. It is to be performed if time allows.Selection #1(Required) Composer #1(Required) Selection #2(Required) Composer #2(Required) Selection #3 (Optional if time allows) Composer #3 (Optional if time allows) Indicate which selection is the required piece(Required)Indicate required pieceSelection #1Selection #2Selection #3ExemptPAY BY CREDIT CARD:Registration Fee per Instrumental Ensemble Price: Registration Fee per Choral Ensemble Price: Processing Fee Price: Processing Fee Price: Total Fees Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Billing Name(Required) First Last Billing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code IMPORTANT: Click "Submit" once only. Allow a minute for processing.A receipt will be sent to the email address you provided. If you do not receive it, please check your other folders. For additional help, contact [email protected]. EmailThis field is for validation purposes and should be left unchanged.
