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Illinois Music Educators Association Participating School Form


Please read instructions before completing


Completion and receipt of this form with required payment will establish your school’s eligibility for the 2011-2012 IMEA District and State Activities. General Information


After a school has “Entered/Updated/Confi rmed” their information in the IMEA Registration/ Nomination/Selection (RNS) online system and submitted this form with proper payment, the State Offi ce will activate the school for access to RNS and the individual student nomination forms. All pertinent information is available on the IMEA website (www.ilmea.org) by clicking on Division Information or visiting individual District web pages. All schools are required to use the RNS system.


Deadlines July 29


Early registration deadline. September 15 Absolute deadline for receipt of this form.


See your District President’s spring newsletter for all student nomination and festival deadlines. Important


IMEA must receive one form and fee for each level of participation from each individual school building. For example, a single school building entering both the Junior and Senior Festivals must submit two $25 Participating School fees.


Please type or print legibly. (Please visit www.ilmea.org for a type-able PDF.)


Performance Level (Check only one per school) Junior $25


IMEA District Number __________ (see map above)


Senior $25


Contact Person for this School (IMPORTANT: List one faculty member as the “Offi cial Contact” for this school. This must be the same Offi cial Contact as used in the RNS system.)


Contact Person _____________________________________________________________________________________ School Name __________________________________________________ School District # ___________________ School Address _____________________________________________________________________________________ City __________________________________________________


School Phone ____________________________


List School Music Department Staff Band _____________________________


Payment Contact Email __________________________________________ Chorus _____________________________


General Music _____________________________ Check Enclosed


Orchestra _____________________________ Jazz _____________________________ Please Charge My (Check One) MasterCard Visa


Name on Credit Card _____________________________________________________________________________________ Credit Card Number _______________________________________ Security Number ________


Signature _____________________________________________________________________________________


Return this form and check to the address below. Form with credit card information may be faxed. IMEA State Offi ce | 18700 Wolf Road, Suite 208 | Mokena, IL 60448-8603 |


Phone: 708.479.4000 | Fax: 708:479.5638 | FINAL DEADLINE FOR RECEIPT IS SEPTEMBER 15, 2011


Fall 2011 | www.ilmea.org Date ________ Check # __________ Amount Received __________ 27 Exp. Date ___________ 6


IMEA District Map 7


8 2 4 5


9 1 3


State IL Zip ___________________


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