Meet a Musician Friendship Program Music Interest Form

Full Name:

My Preferred Name:

Phone Number

Email Address

Languages I Speak:

My Age:

<65 65-75 75-85 85<

Accommodation Type:

Privately-owned or rental property Retirement Village Aged Care Facility

Rep Name:

Rep Relationship:

Rep Phone Number

Rep Email Address

Other/ Comments

My Favourite Music Era/s:

20s, 30s, 40s e.g. Louis Armstrong, Frank Sinatra 50s e.g. Elvis Presley, Dean Martin 60s e.g. The Beatles, Beach Boys 70s e.g. Led Zeppelin, Pink Floyd 80s e.g. Bruce Springsteen, Queen 90s e.g. U2, Nirvana 2000+ e.g. Coldplay, Red Hot Chilli Peppers

Other/ Comments

My Favourite Composers:

Bach Beethoven Chopin I'm not into classical music

Other/ Comments

My Favourite songs:

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In the spirit of reconciliation Memory Nurture acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea, and community. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

Meet a Musician Friendship Program Music Interest Form

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