NAME: _____________________________________
ADDRESS : ___________________________________
CITY : ________________________________
STATE: ________________
ZIP: _________________
Male: _____ Female: _____
Age: _____
Email address: __________________________________________
Year in School - Entering Grade in Fall 2010: _______
Parent or Guardian: _____________________________
Home Phone: _________________________________
Emergency Phone: ______________________________
Instrument: ____________________________________
Voice Type: ___________________________________
Do you want to be in a Jazz Ensemble ? ______________
T-Shirt Size ( included in Camp Fee ) Adult S M L XL XXL
Payment Enclosed:
_____ $50.00 Deposit (NON-Refundable)
_____ $375.00 Total Fee (If registered before May 15, 2010)
_____ $395.00 Total Fee (If registered AFTER May 15, 2010)