Registration Form: Use a separate form for each person;
photocopy or print as needed.

Name____________________________________________________________________________

Street Address__________________________________________________________________

City______________________________________ State ____ Zip ______________________

Day phone____________________________ Evening phone_____________________________

E-mail address ________________________________________

Register:

____Arranging for the Mountain Dulcimer September 22 - 23 @ $100 _____

TOTAL amount enclosed:_______

Payment: ____MC ____VISA ____Check: (Make payable to JC Rockwell Music)

VISA/Mastercard No:_________________________________________ Exp. Date _______________

Cardholder's signature _________________________________________

Registration deadline: September 18, 2001. Provided we receive your registration by
the class deadline, we will mail letters of confirmation. Lodging and food arrangements
are the responsibility of the individual participant.

Questions? Call: 740-662-3011
e-mail jcrockwell@gmail.com

Mail the completed form with payment to:

J.C. Rockwell Music
PO Box 79
Guysville, OH 45735-0079

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E-mail: Logschool@jcrmusic.com