2004 WORKSHOP APPLICATION

Please print this blank form, fill it out by hand, and "snail mail" it with your deposit to the address below.

Name:

Date:

Circle one:      Art   Choral   Gen Music   Orch Cond   Piano   Strings

Address:

Telephone:  (          )

Fax:  (          )

Email:

Occupation:

Other musical/art interests:

Strings: ASTA (AUSTA, etc.) member?:      Yes   No

Instrument you plan to bring:

Singers:      S   ·   A   ·   T   ·   B


Please circle appropriate categories:

Male  · Female

Smoker  · Nonsmoker

Under 21  ·  21-35  ·  36-45  ·  46-60  ·  over 60


List yourself and each family member accompanying you. Circle the proper fee category and applicable adjustments for each.
Compute the net fee for each person and indicate the total due.

Name

Category

Adjustments

Fee Per Person

 

1   2   3

A   B   C   D   E   F   G   H   I

$

 

1   2   3

A   B   C   D   E   F   G   H   I

$

 

1   2   3

A   B   C   D   E   F   G   H   I

$

 

 

 

 

Total Due:

__________

Deposit Enclosed ($350 per person):

__________

Balance Due by June 1, 2004:

__________


If you are coming with a roommate, please give name: _____________________________

Please send this completed form with $350 per person deposit to:
   International Workshops
   187 Aqua View Drive
   Cedarburg, WI 53012
   USA