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Eastern Iowa Clarinet Camp |
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Application form
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Application
for Participation in Eastern Iowa Clarinet Camp Name ____________________________________
School attending ________________________________________ Address __________________________________
Year ___________________________Age ___________________ City ________________State_________Zip______
Emergency contact ______________________________________ Phone ____________________________________
Relationship ___________________________________________ Email ____________________________________
Phone (home)______________________(work)_______________ Payment
Payment Options Please check the appropriate option:
______Payment in full
______Pay $25 deposit; pay remaining balance by May 9* ______$275 for residents-includes camp fee, room *$20 late
fee if full payment not received by May 9, 2008 and board, and most meals ______$225 for commuters-includes camp fee and Please
make check or money order out to EICC and send to: and most meals
Myron
Mikita ______$85 for daily commuters (one day at a time)
Don
Bosco High School includes camp fee and
meal for the day
405 16th Ave. P.O. Box 106 *Masterclass fee not due until day of registration
Gilbertville, Ia 50634-0106
Total Payment Encolsed to EICC $
________ Student Signature ________________________________ Parent Signature _________________________________________ |
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