Print out and complete this form,
or write out the information on a separate sheet


$50 deposit holds your spot.
Balance due one week before class.

Mailed registration with total payment of $125 must be postmarked by Feb. 24.

Prefer to pay with PayPal? Click here

Send check or money order (payable to Wernick Method) plus completed registration form to:

Wernick Method
2317 Barnetts Creek Rd.
Columbia, KY 42728


Sign me up for Bluegrass Jamming Class
Please confirm my registration and send full orientation info.

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

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

How did you FIRST hear about this class?
___ 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: _____________________________________________)