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Folk Arts Music Workshop ADULT Registration
Workshop Choice
*
Jamming
Songwriting
Participant Name
*
First Name
Last Name
Contact Information
Please enter parent/guardian contact if participant is a minor
Email
*
Phone
*
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Instrument:
*
Tell us about your songwriting experience (no experience necessary):
*
Do you plan to bring original material to the workshop?
*
Yes
No
Not Sure
Experience level (suzuki book if violin; years playing; or other descriptors):
*
What do you hope to get out of this workshop?
*
Allergies or Other Concerns
Allergies and other medical or behavioral concerns HCOA and program/event leaders and teachers should know about (this information will only be shared on a need-to-know basis)
Liability Release
*
I hereby waive any liability for injuries/illness sustained at this program/event produced by Homer Council on the Arts. I also accept legal and financial responsibility for the above-named participant(s) in the event of injury or illness.
Consent for Treatment
*
I consent to allow the above-named participant(s) to receive emergency treatment, hospitalization, or other medical treatment by a physician, qualified nurse, or hospital if necessary because of an injury or illness.
Media Release
*
Yes. Homer Council on the Arts may use photo/s or video/s of the above-named participant for promotional purposes. I understand that names and other personal information will not be released.
No. Homer Council on the Arts may not use photo/s or video/s of the above-named participant promotional purposes. I understand that the participant will be excluded from group photos.
Amount
$75
-
General
$60
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HCOA Member
$0
-
Pay with cash or check
Add 3% to my total amount to help cover the payment processing fees