VBODA District ______             School Name ________________________________

Address _____________________________ City ___________________ Zip _________ - ______

School phone _______ - ____________

This fee is being paid by  ______ Band Director  _______ String Director  ________Both

School is a  ______ high school   ______ middle school   ______ elementary school

Send check (payable to VBODA for $50) and copy of form to:

Wayne Powell

Yorktown Middle School

11201 George Washington Mem Hwy

Yorktown, VA 23692