Blues Mandolin Workshop Registration Form

Registration Deadline: March 16th, 2007

Name________________________________________________________

Address ______________________________________________________

Phone________________________________________________________

E-mail _______________________________________________________

Male_____ Female______

Cost: $ 390.00             

Amount Enclosed $________________

How did you learn of this workshop? ______________________________________________________________________________

Make Check Payable & Mail registration form to:

Holiday Lake 4-H Educational Center

1267 4-H Camp Road

Appomattox, VA 24522

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Standard Mandolin Building Workshop

Refund Policy

Full: by March 16th, 2007

50% : after March 16th, 2007

Nonrefundable after March 23rd, 2007

If you are a person with a disability and desire any assistive devices, services or other accommodations to

participate in the Workshop, please contact The 4-H Center no later than two weeks prior to the date

assistance is needed between the hours of 8:00 a.m. – 4:30 p.m. Monday through Friday.