Yamaha Online Clinic Request Form

Band & Orchestral Product Registration Canada

Would you like to produce a clinic with a Yamaha Artist? Use this form to tell us about your event, and Yamaha Canada Music will review it to determine whether we can provide financial support.

This form should be used by educators, dealers, and event coordinators who regularly use Yamaha instruments. Requests must arrive at least 60 days prior to the scheduled event.

Completion of this form does not guarantee a financial contribution from Yamaha Canada Music. You will receive a reply by email within three business days. This form must be filled out completely in order to be considered for support.

* = Required Field

* Event Type:

In-store Clinic	Professional Convention
High School Masterclass / Clinic	Regional Music Festival
University Masterclass /Clinic	Other

* Date of Event:

* Event Name:

* Event Location:

* City:

* Province:

* Expected Clinic Audience:

* Expected Masterclass Participants:

* Contact Name:

* School / Institution / Dealer:

* Mailing Address:

Unit/Suite # :

* City:

* Province:

* Postal Code:

* Email Address:

* Phone Number:

* Clinician / Artist Name

* Email Address:

* Instrument:

* Clinician Fee:

Travel Expenses (if applicable):

Other Expenses:

* Host Contribution:

* Dealer Contribution:

Other Contributors (Please list):

* Amount Requested of Yamaha:

* Dealer Name:

* Contact Name:

* City:

* Province:

* Email Address:

* Phone Number:


CLINIC PROGRAM AGREEMENT
As the host of this event, you will agree to distribute literature provided by Yamaha Canada Music and/or the Clinician. You may also arrange with the dealer to display Yamaha instruments for student and customer trials.

	I have read the agreement and, if funding is awarded, will abide by these requirements.