Fall 2006 EAST COAST JAM Registration

Name:  _________________________________________________________________

Address: Street: __________________________________________________________

         City:   __________________________ State: __________ Zip: _________

         Phone:  __________________________

         Email:  ___________________________________________________________

I will be there for the entire jam  -   O-Yes  O-No (detail in arrival/departure section, below)

I will be there for part of the jam:

  Arrival time and date:   ______________________________

  Departure time and date: ______________________________

Meals are vegetarian -- any other dietary need?  (We can not guarantee
specific diets, but will see if we can accommodate you if you let us know
ahead of time.)  Details:

__________________________________________________________________

__________________________________________________________________

Other requests?

__________________________________________________________________

Is email confirmation ok?   O-Yes   O-No

Do you need a ride?   O-Yes   O-No

Can you offer a ride?   O-Yes   O-No

To register, send a non-refundable check for $50 *made out to
"Michael Hurd"* and a copy of this completed form to:

    Michael Hurd
    580 Panther Branch Rd
    Alexander, NC 28701

The total cost for full attendence (including meals, room, and board) is $290,
with the balance payable on arrival.  Workstudy is available, if arranged
sufficiently in advance, to cover some of the cost.

See you there!