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 including lodging and meal packages available from Camp Harrison. Info is also available on the Camp Harrison site. For offsite accommodations: www.merlefest.org.

[ ] REGULAR TUITION ($350)
[ ] Save $10: $340 if paid in full by Feb. 23, 2012
[ ] $120 deposit enclosed, $230 due on arrival.

All but 50% of deposit amount refundable until Mar. 23th.

Name: ________________________________________________

Address: ______________________________________________

City, State, Zip: _________________________________________

Main telephone: ________________________________________

E-mail: _______________________________________________

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

Can you "fake" solos on your instrument?
[ ] no   [ ] sometimes   [ ] usually

Jam experience? [ ] never   [ ] rarely   [ ] 5-15 times   [ ] 16+ times

Singing experience: [ ] sing lead   [ ] can lead a song   [ ] harmony

Most interested in our:
[ ] Novice/basic track or [ ] Intermediate track?

How did you FIRST hear about this camp?
___ DrBanjo.com
___ magazine ad (which magazine?________________________)
___ radio (what station? ____________)
___ article in newspaper or magazine (which one?_____________)
___ the festival's web site
___ flyer (where?_______________________________________)
___ Dr. Banjo email newsletter
___ music teacher (who? _________________________________)
___ from a former camper (who? ___________________________)
___ other: _____________________________________________)

Mail to DR. BANJO 7930-P Oxford Rd. Niwot, CO 80503.
Checks payable to Dr. Banjo.