2005 Jamberoo Valley Folk Music School Registration Form

Print this form and fax to 02 4257 1787 or send to: Illawarra Folk Club, PO Box 5289, Wollongong, NSW 2500

Enquiries: Jane Brownlee 0414 443 523, jane@illawarrafolkclub.org.au

Your Details

Emergency Contact Details

Class

Tick the box to indicate your choice:

 Fiddle (beginner to intermediate)   Fiddle (advanced)

Costs

Tuition cost per day is $30. Accommodation, meals and transport are not included.

Please indicate the option you prefer:

 All 3 days and Saturday Night Dinner - $105 (includes complimentary ticket to Folk in the Foothills)

 All 3 days - $90 (includes complimentary ticket to Folk in the Foothills

 Thursday - $30   Friday - $30   Saturday - $30

PAYMENT OPTIONS Full payment is required by 30 September 2005.

Paying by Cheque / Money Order / Credit Card (Please Circle)

Amount of this payment $ ________.

Receipt(s) for all payments will be issued at the school. Use a copy of this form if paying the remainder.

If paying by credit card you can fax this form to 02 4257 1787, otherwise post to: Illawarra Folk Club Inc., PO Box 139, Keiraville, NSW, 2500

Payment details: Bankcard Mastercard Visa

Card No. __________/__________/__________/__________/__________

Exp Date: _____/_____

Cardholder's name:_______________________________

Signature:_______________________________________