Akademie- & Konzertbüro Klaus Richter
Potsdamer Straße 109
D-10785 Berlin

Tel.& Fax.: +49-30 / 265 547 70     e - mail : klaus@richter-berlin.de

11th International Masterclass Kröchlendorff Castle 2005

Application Form

[  ] Violin   [  ] Viola   [  ] Cello   [  ] Chamber Music   [  ] Special

Professor: ______________________

Surname: ______________________    First name ______________________

Date of birth: ____________      Nationality: ______________________

Please, mark the matching word:   [   ]  male   [   ]  female

Address:

Street: ____________________________________________________________

Postal code: ____________     City: ________________________________

Telephone: ________________________     Fax: _______________________

Teachers(s): _______________________________________________________

City: ______________________________________________________________

Application as:    [   ]  active participant    [   ]  listener

Prepared pieces: ___________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Arrival date: ____________    [   ]  by car    [   ]  whithout a car

Other: _____________________________________________________________

I will transfer the Registration fee (EUR 80,--) by
Febrary 14th 2005.
The course fee (EUR 180,--) & costs for room and board (EUR 225,--) are
due by February 20th 2005 to:

Klaus Richter    account number: 1824002439     at the
Berliner Sparkasse     bank number (BLZ): 100 500 00
keyword: ``Meisterkurs 2005''

Date: ____________     Signature: ___________________________