PLEASE PRINT OUT ALL THREE FORMS, INCLUDING THIS REGISTRATION FORM, THE MEDICAL FORM, AND THE RELEASE FORM AND FILL THEM OUT AND MAIL OR FAX TO:

DR. RENE GONZALEZ, DIRECTOR
GUITAR CAMP
UNIVERSITY OF MIAMI
P.O. BOX 248165
CORAL GABLES, FL 33124

OR FAX FORM TO:
FAX: (305) 858-0535

PHONE: (305) 858-8189 (EFM)
or
(305) 284-2083 (Dr. Gonzalez)

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Check or Money Order Should be Made Payable To:
UNIVERSITY OF MIAMI

(The Rest of the Payment Must be Received by June 1, 2011 to Secure
Your Spot)

To Charge Camp Fees to VISA or MASTERCARD, Complete the Following:

VISA or MASTERCARD (Circle One)

Expiration Date: ________________________________

Name on Card: _________________________________

Card Number: __________________________________

Signature: ______________________________________

Amount to Charge: $ _____________________

_______Non-Refundable $25 deposit enclosed

Please Circle Appropriate Fees:

REGULAR CAMP: Grades 5 through 12 (including Pre-college)...............$295
(additional family members $195)
(For Guitar, Bass-Guitar & Drumset )
(Fee includes Books, Materials, Lunch and Camp T-Shirt.)

Dormitory/Housing: ($25 per night @ 6 nights)........................................$150

Extra Meal Plan: (Breakfast & Dinner for Overnighters)........................................$80

Registration Fee: (For all campers)..........................................................$ 25

TOTAL AMOUNT DUE:..............$_______________

NAME: _________________________________________________________________________

ADDRESS:_____________________________________________________________________

(City) (State) (Zip)______________________________________________________________

SCHOOL NAME:________________________________________________________________

AGE: ______________ GRADE: ______________

PARENT WORK PHONE: ( ___)__________________2nd PHONE: ( ___)__________________

FAX:( _____)_________________________ HOME PHONE: (______)________________________

CELL PHONE: (_______)_____________________BEEPER: (_______)_________________

EMAIL ADDRESS: _________________________________________________________________

INSTRUMENT(s): Check by Appropriate Instrument:

POP-ROCK GUITAR ________CLASSICAL GUITAR__________BASS-GUITAR __________

DRUMSET_________________

YEARS OF STUDY: In School _________Private Teacher __________

Ensemble Experience_____________________________________________________

__________________________________________________________________

FEES: (Check Appropriate Space) Includes all Instructional Materials, Lunch, and Camp T-Shirt

CHECK ONE: T-SHIRT SIZE: (MEN'S) ____SMALL ____MEDIUM ___LARGE ____ X-LARGE

ADDITIONAL $4.00 FOR THESE SIZES: 1X ____ 2X ____ 3X _____ 4X ____