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All members (new and returning/veteran) must complete and submit this form in order to be a member during the 2012 Season.

Title:  
First Name:
(as it appears on
your driver license)
Middle Name:
(as it appears on
your driver license)
Last Name:
(as it appears on
your driver license)
Suffix:
 (if applicable)		  
Preferred First
Name:
 (if different than your name above)
ECU ID Number:
(Banner ID)
Sex
Date of Birth:
(mm/dd/yyyy)
Age:
Weight:
Allergies and any Special Dietary Needs/Restrictions:
Current Medications:
(please list dosage and frequency)
In case of emergency, notify: Name:

Relationship:

Telephone Number:

Alternate Telephone Number:

Insurance Company:

Policy Number (if known):
Permanent/Home
Mailing Address:		 Number and Street:

City, State and Zip Code:
Permanent/Home
Telephone Number:
(xxx-xxx-xxxx)
Cell Phone Number:
(xxx-xxx-xxxx)
E-mail
Address:
Do you plan to participate in early residence hall move-in? Yes No
Address While Attending ECU: Number and Street:


City, State and Zip Code:
Graduated/
Transferred from:

Band Director’s Name (if applicable):
Number of years in the ECU Marching Pirates:
(include this
coming year)		  
Fall 2012 Classification:  
Intended Major:
Performance Area:
 (select only one)		  
Do you need an
ECU instrument?		 Yes No
T-Shirt Size:  
Comments/
Questions:
Contract
Agreement:

By completing and submitting this form, I:

  • Agree to being a member of the ECU Marching Pirates for the 2012 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 2012-2013 academic year.

 

ECU Marching Pirates
School of Music | East Carolina University
East Fifth Street | Greenville, NC 27858
 252-328-6982 phone | 252-328-6258 fax
MarchingPirates@ecu.edu

"The Sound of Pirate Nation"