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Selmer® Clinician Program Request For Financial Assistance


Your Name:
School (or Dealer) Name:
Address:
City, State, Zip:
Email Address:
Phone Number (Day Time):
Festival Name (If Applicable):
Date Of Clinic:
Clinic Location:

Anticipated Number of Clinic Participants:
Clinician's Name:
Total Clinician Fee:
Total Clinician Expenses:

After you have successfully completed this form

The Selmer® Company provides partial funding for educational related clinics and masterclasses. All requests must be submitted in writing to the Selmer® Marketing Administrator at least thirty days prior to the event. Based on approval, a contract will be issued indicating the amount of Selmer's® participation, one copy of which must be signed and returned prior to the event.

The Selmer® Company, Inc.
P.O. Box 310
Elkhart, Indiana 46515
Fax (219) 295-5405