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Registration
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"The Medical Form"
Click here to see about the camp and the faculty
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)
IMPORTANT!!!! ALL CAMPERS!
PLEASE READ, SIGN AND FAX ALONG WITH THE ABOVE “REGISTRATION FORM” BEFORE
JULY 10, 2003


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

(The Rest of the Payment Must be Received by July 10, 2003 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


CAMP 1: Ages 5 through 7 (From 9am to 12 Noon)..............$155
(additional family members $110)
(For Guitar, Bass-Guitar,Drumset & Keyboard)
(Fee includes Books, Materials Snack and Camp T-Shirt.)

CAMP 2: Ages 8 through 11 (From 9am to 3pm)..............$195
(additional family members $155)
(For Guitar, Bass-Guitar,Drumset & Keyboard)
(Fee includes Books, Materials Snack and Camp T-Shirt.)

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

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_________________KEYBOARD ____________________

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 ____


Please Circle Appropriate Fees:

Please Type or Print Clearly
Please Use One Form per Student

REGISTRATION FORM

THE UNIVERSITY OF MIAMI’S
12th ANNUAL SUMMER
GUITAR, BASS-GUITAR, DRUMSET & KEYBOARD
JUNIOR CAMP
July 28 - August 1, 2003