-=[ NORTHEAST HERITAGE MUSIC CAMP 2012 REGISTRATION ]=-

NAME: _______________________________________________ PHONE: ___________________

STREET ADDRESS: _____________________________________ AGE: _____________________

CITY/STATE/ZIP: _____________________________________ TODAY'S DATE: ____________

EMAIL: ______________________________________________ T-SHIRT(S): ______________
                      T-shirts: $15 up to XL, $17 XXL & up, +$3 for long-sleeve

MAIN INSTRUMENT: a_Fiddle b_Piano c_Flute/Whistle d_Accordion e_Banjo f_Guitar
f_Guitar g_Mandolin h_Bass i_Pipes k_Voice j_Other (specify) ___________________

SKILL LEVELS:                           d_INT. (>12 months; tunes at med. speed)
a_RANK BEGINNER (never played before)   e_HIGH INT. (2 or more years)
b_BEGINNER (up to ~6 months playing)    f_ADV. (many years; most tunes at speed)
c_LOW INT. (~6-12 months; slow tempos)  g_PRO. (play on stage in working bands)

JAM PREFERENCES:                        d_Want a medium jam (easy tunes/tempos)
a_I'm new at this; get me started!      e_Want an up-to-speed jam (std. tunes)
b_Need slow tempos & simple tuness.     f_Want a no-holds-barred jam
c_Need someone to call chord changes.   g_Want to watch no-holds-barred jams

CLASS INTERESTS; check the 4 classes that you are most likely to attend:
(This is for our planning purposes only; you may change your mind at any time.)
FIDDLE
   Irish: a_lower intermediate / b_upper intermediate / c_ advanced
   Quebecois: d_lower intermediate / e_upper intermediate / f_advanced
   Scottish - Cape Breton: g_lower intermediate / h_upper intermediate / i_ advanced
   Appalachian Old-time: j_lower intermed. / k_upper intermediate / l_advanced 
   m_Swedish  /  n_Improv for Fiddlers  /  o_Novice  /  p_Novice Plus
PIANO ACCOMPANIMENT: q_Basic / r_Advanced 
CLAWHAMMER BANJO: s_Beginning / t_Intermediate / u_Advanced
GUITAR: v_Celtic_Accompaniment / w_Fiddle Tunes / x_Swing Chords
BAND: y_Southern_String_Band / z_Swing_Band / A_Irish Ceili Band
DANCE: B_French-Canadian_Step-Dancing / C_Contradance_Calling
REPERTOIRE CLASSES: D_Cork & Kerry Tunes / E_New Contra Dance Tunes
MISC: F_Flute & Whistle  /  G_Accordion /  H_Mandolin  /  I_Shape-Note_Sing 
 
If we hire more teachers, whom would you like to see added?_____________________

First time attendees: how did you hear about NHMC?______________________________

COSTS
       Resident reg. fee is US $770 - tuition, board, & room (double occupancy)
       Commuter reg. fee is US $525 - tuition only, no room or board
       Spouse reg. fee is US $385 - everything but classes
$_____ registration fee
$_____ single room option (US $25 extra)
$_____ T-shirt cost, total for all shirts ordered above
$_____ optional contribution to the NHMC Youth Scholarship Fund

$_____ Total cost (in US $)

I'm paying:  __the full amount now   __a $200 deposit (OK until 4/15, see notes)

I'm paying by: (pick one)  __Check or Money Order   __Visa   __Mastercard

Visa/Mastercard #: _______________________________________   Exp: _____/_____
Name on Card ____________________________
Billing address(if different):__________________________________________________

Lodging:     women: __Women-only floor   __Coed floor okay   __female Commuter
(PICK ONE)     men: __Men-only floor     __Coed floor okay   __male Commuter

Dorm area:   __Near the action!       __Normal quiet wing    __VERY quiet area!

Emergency contact (Name, Relationship, Phone):

Any dietary or physical issues we should know about: