2011 Fiddleheads Camp Registration Form

Name:___________________________________________________

Address:_________________________________________________

City, State, Zip:________________________, ________, _______

Phone: (______) _________- ____________

E-mail Address________________________________________

Instrument(s) Played: ____________________________________________________________________

Level: Beginner Intermediate Advanced

Years Playing:___________________________________

Your Age_______ (for rooming purposes)

If we don't know you already, tell us a little about yourself and what you hope to get out of this workshop:

____________________________________________________________________________________________________

Number of Attendees	Request	Fee	Total
.	Workshop Tuition, All Participants	$165- $195
.	Meal and Housing fee
	for Day Campers: facility fee	$45
.	Circle One: (Retreat Center) A B (Cabin) C D E
	Band discount (3 member minimum)	-$15 per person
	(Please see below for accommodation fees)	Grand Total ->	$

Registration Procedure:

1. Print Form (Click this button) ->

2. Fill in the requested information

3. Attach fee in the form of check or money order made out to Ellen Carlson

4. Mail this form, with your fee, prior to August 21, 2011 to:

Ellen Carlson

PO Box 62

Lochmere NH 03252

Accommodations and Fees are listed here