Band Camp Registration Please fill out the following form by July 15, 2023. Personal InfoName* First Middle Last Suffix Preferred First Nameor nickname, if different from above. ECU Banner ID Number* ECU Email Address*Use ONLY your email address ending with @students.ecu.edu. Account Information Enter Email Confirm Email Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*at the beginning of band camp. Home/Permanent Phone Number*Student's Cell Phone Number*Parent/Guardian Email* Home/Permanent Mailing Address* Street Address Address Line 2 City 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 State ZIP Code Medical History*Please list all medical conditions and major surgeries.Allergies and any Special Dietary Needs/Restrictions:* Are you a vegetarian or vegan?* No Yes, Vegetarian Yes, Vegan Current Medications*Please list dosage and frequency. Emergency ContactEmergency Contact Name* First Last Relationship* Emergency Contact Phone Number*Alternate Phone Number*Insurance InformationCompany Name* Policy Number* Other InfoWhat is your academic designation at ECU?* Freshman Sophomore Junior Senior Super Senior Is this your first year in the Marching Pirates?* Yes No Graduated/Transferred From What School?*For new students only... all others may put NA. Former Band Director's Nameif applicable Former Band Director's Email How many years have you been a member? (Including this year)* 2 3 4 5 Intended Major* What is your current GPA?* List any clubs of which you are a part.*including fraternities, sororities, religious/spiritual clubs, academic clubs, cultural clubs, etc.Why do you want to be part of the Marching Pirates?*Check all that apply. I wanted to continue my music/marching at college. Previous family members in band. Scholarship/stipend opportunity Friendships High Profile Performance Opportunities Something New Become Involved on Campus Other If other, please explain.*Instrument/Performance Area* Piccolo Clarinet Alto Saxophone Tenor Saxophone Trumpet Mellophone Trombone Baritone Sousaphone Drumline Colorguard Dance Team Feature Twirler Drum Major Do you own your own marching instrument?* Yes No NA (for guard, dance, drumline, drum major, twirler, sousaphone) Additional Comments/QuestionsAgreementBy completing and submitting this form, I: Agree to being a member of the ECU Marching Pirates for the 2023 season. Submitting this form shows that I understand that I must fully attend Preseason Band Camp and complete an audition in order to earn a spot within the band. Agree that in the event that I am rendered unable to communicate due to illness, accident or emergency while participating in activities of the ECU Marching Pirates, I hereby give permission to a Physician selected by the ECU Marching Pirates staff to hospitalize, secure proper treatment for and to take whatever medical actions are necessary to treat me. I further authorize payment for treatment either by me personally or through my medical health insurance provider. Agree that I have read, understand and will abide by the expectations, policies and guidelines for all members of the ECU Marching Pirates for the 2023-2024 academic year. Please read the above carefully before checking this box.* I AGREE EmailThis field is for validation purposes and should be left unchanged. Δ