Acoustic Camp Midwest - Registration

First Name:		Last Name:
Address:
City:
State:		Zip:
Work Phone:		Home Phone:
Mobile Phone:
E-Mail:

Gender (for room assignment purposes):	Male Female	Age:

Credit Card Type:
Credit Card Number:		Expiration Date:

Please register me for the following (prices include taxes):
Colony Oaks Suite with Kitchen (Private) - $547.50 Colony Oaks Standard Room (Private) - $513.90 Colony Oaks Standard Room (Shared with another attendee) - $418.70 Guest House Inn Standard Room (Private) - $463.50 Guest House Inn Standard Room (Shared with another attendee) - $390.70 I have a traveling companion attending all sessions - $267.50 I have a traveling companion that will need meals only - $107.00 I will attend all sessions but do not need hotel accommodations - $267.50 Companion Name:

Special Requests/Concerns:

Instrument (check all that apply):	Banjo Bass Fiddle Guitar Mandolin Other (Specify)
Other:

After submitting, an email confirmation will be sent to the email address you supplied.

Acoustic Camp Midwest - 319.622.6222