Student's Name:

Age: (if under 18)

Sex: Male aaaa Female

School:

Grade (i.e. 7th, 8th, etc):

Instrument :

Years of study on your instrument:

Private Instructor:

Band Director:

Parent/Guardian:

Mailing Address (street, city, zip):

Primary Phone:

Alternate Phone:

Email:

REGISTRATION:

I would like to register for the Double Reed Workshop, including room and board at Stetson University: $395

I would like to register for the Double Reed Workshop, including lunch and dinner at Stetson University (local students only): $295

I would like to receive my information packet via email (April, 2008)

I would like to purchase a t-shirt for $15

I can bring an English Horn (oboe players only)

T-Shirt Size

S aaaa M aaaa L aaaaXL

If you have a room mate that you would like to be assigned, enter their name in the space provided:

Comments or Questions: