Spring 2008 EAST COAST JAM Registration

Name:  _________________________________________________________________

Address: Street: __________________________________________________________

         City:   __________________________ State: __________ Zip: _________

         Phone:  __________________________

         Email:  ___________________________________________________________

I will be there for the entire jam  -   O-Yes  O-No (see 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 cannot 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 sufficient?   O-Yes   O-No

Do you need a ride?   O-Yes   O-No

Can you offer a ride?   O-Yes   O-No

Do you need:    O-work-study    or    O-scholarship?
      (availability limited; work-study requests must be made before March 28)

To register, send a non-refundable check for $50 made out to
"East Coast Jam" and a copy of this completed form to:

  Gary Kuntz
  PO Box 491
  Williamsburg, MA 01096

See you there!