Sign me up for Pete Wernick's Bluegrass Jam Camp!
Morehead, KY (May 30 and 31, June 1, 2007)
Print out and complete this form, or write out the information on a separate sheet:

Sign me up for Bluegrass Jam Camp!
Please confirm my registration and send full orientation info.
Accommodations info at www.morehead-st.edu/kctm/bnm/

[ ] REGULAR TUITION ($195)
[ ] $75 deposit enclosed, $120 due on arrival.

There are 6 spots left in this camp as of May 13, 2007.

In addition to mailing in the registration form and deposit, be sure to send Pete Wernick an email at pete@drbanjo.com, stating you've sent in your registration. Include what instrument you play.

Note: After May 21, 2007 do not send a registration form, but email Pete the information requested on the form.

Please answer all questions on this form. You are welcome to enclose further information about your experience and concerns.

Name:________________________________________

Address:_________________________________________________

City, State, Zip: ___________________________________________

Home telephone number:____________________________________

E-mail ___________________________________________________

Check which instruments you play, and circle the main one:
[ ] guitar [ ] banjo [ ] mandolin [ ] fiddle [ ] bass
[ ] resonator guitar (dobro) [ ] other: _____________ [ ] none

Do you sing? [ ] yes, know many songs [ ] a little [ ] no
Jam experience? [ ] never [ ] rarely [ ] 5-15 times [ ] 16+ times