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Registration: NWMC April 22 - 24, 2011 Name: __________________________________ Deposit amount enclosed: ________Address:_________________________________________________Zip___________ Email: _______________________________ Check here if you do NOT want your email given out on our camp list ___ Phone: (day) (______) _______________________ (cell) (______) ____________________ During the weekend, who should we contact in case of emergency? _______________________ Phone #:_______________ Your physician? ____________________________________ Phone #:_______________________ Do you have any allergies? _______________________________________________________________ If Buddy, then Buddy's: Name: __________________________________ Deposit amount enclosed: ________Address:_____________________________________________________ Zip___________ Email: _______________________________ Check here if you do NOT want your email given out on our camp list ___ Phone: (day) (______) _______________________ (cell) (______) ____________________ During the weekend, who should we contact in case of emergency? _______________________ Phone #:_______________ Your physician? ____________________________________ Phone #:_______________________ Do you have any allergies? ____________________________________________________ Rates: $260/person before February 1st; buddy rate: 2 for $500. $275/person after February 1st. Please send a $50 deposit, per person, with this registration: make checks payable to Motherlode Music. Your deposit is refundable until April 15th. The event will begin at 2 pm on Friday, April 23 and end about noon on Sunday, April 25. Please plan to bring an instrument for the workshop you want to take.
Print and mail this form, along with your
deposit, to Registrar/NWMC, 6023 N.E. Beech, Portland, OR, 97213. Thanks! |