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From Women's Hearts and Hands Guitar Camp Registration Form
   Camp Dates: January 14 - 17, 2011 (MLK, Jr. Birthday Weekend)

The Registration process consists of two steps:

       FIRST, please complete the form below and submit it by December 6, 2010.

       SECOND, visit the Make A Payment page to pay online or to find out how to
       pay with a check. Payment must be received by December 6, 2010.

We can not consider you "registered" until we receive both your Registration Form and Payment.

We use this information to plan classes, meals, and activities that address your needs and interests. We work hard to create a curriculum that responds specifically to the interests and backgrounds of women who participate. To ensure that you are happy with our cuisine, we ask about your preferences and allergies. So, please answer all questions. We will never sell your information or share it with any other person or organization. The information you disclose goes no farther than the directors of From Women's Hearts and Hands Guitar Camp. We look forward to meeting you and studying with you at camp!

Contact Information

Today's Date:
First Name: Last Name: Age: Occupation:
Home Phone: Work Phone: Cell Phone:
Email Address:
Snail Mail Address:
City: State: Zipcode:
Emergency Contact Name: Emergency Contact Phone:

How did you hear about From Women's Hearts and Hands Guitar Camp?
Please check all that apply:
Acoustic Guitar Magazine Study Guide.
Friends.
WACCOBB.net.
Acoustic Guitar Forum Electronic Bulletin Board.
Saw posted flyer. Location and city?
Received flyer in the mail.
Music Club Newsletter.
Craig's List.
Internet Search. What search terms did you use?
I am a returning camper.

Payment Information
You may pay by check, or via PayPal. If you pay via PayPal, they take some of your money. For this reason, we prefer that you pay by check.

By what method are you submitting your Registration Fee? Please select from the drop-down menu.


On what date will you mail or deliver your check, or pay via PayPal?


Lodging Preference
Please note that all Farmhouse bedrooms are upstairs, and all Farmhouse bathrooms are downstairs.

Please indicate your lodging preference by selecting from the drop-down menu.


If lodging away from camp, where will you be staying?


If you want to sleep in the Farmhouse, are there friends attending camp with whom you would not mind sharing a queen size bed?
Yes No
Please name:

Your Condition?
Please describe any physical or mental condition that will adversely affect your participation in this camp, or about which we should know:

Travel Arrangements
Can you offer anyone a ride to camp? Yes No
If so, from what city?
Do you need a ride to camp: Yes No
If so, from what city?
Please check here if you are flying to San Francisco International Airport (SFO), and would like to rendezvous with other Guitar Campers at the airport and carpool to camp. We'll send you contact information for other fliers so you can coordinate your travel plans.

Dietary Preferences
Please check items that best describe you:
I am a Vegetarian (entirely meat free: i.e., no fish, chicken, beef, etc.)
I am a Vegan (meat free and dairy free)
I am a Vegetarian and I eat Fish.
I eat Fish but not Chicken.
I eat Fish and Chicken.
I eat Chicken but not Fish.
I drink Caffeinated Coffee.
I drink Decaffeinated Coffee.
I drink Caffeinated Coffee in the morning, Decaffeinated Coffee in the afternoon and evening.
I drink only tea.
Please list any food or other allergies that affect you:

Level of Experience Playing Guitar
Please read the following description and check the number that best describes your level of experience playing guitar.
Level 1: Just learning first chords; can't yet change chords without pausing to relocate fingers.
 Level 2: Can move among at least 4 chords without pausing. Can maintain a steady rhythm. Disdain barre chords.
Level 3: Can Fingerpick smoothly; can play barre chords easily; can arrange songs; can sing and play simultaneously.
Level 4: Can easily play many chords above the 7th fret. Can create many different grooves. Can play chord progression simultaneously with melody line. Can understand Chord Theory.

How well can you Fingerpick?

Musical Preferences
Please use the "Drop-Down" menus to select the four styles of music to which you most enjoy listening. "First Choice" indicates your top favorite style; "Second Choice" indicates your second favorite style, etcetera.
FIRST Favorite. Please select one option:
SECOND Favorite. Please select one option:
THIRD Favorite. Please select one option:
FOURTH Favorite. Please select one option:

In order to help us decide what classes to offer, please use the "Drop-Down" menus to select your top four study choices. Number "1" indicates greatest interest. Please note that your present choices do not commit you to anything. We will offer about half of these classes during eight study periods at camp, and you can decide then what you want to study.
FIRST Choice. Please select one option:
SECOND Choice. Please select one option:
THIRD Choice. Please select one option:
FOURTH Choice. Please select one option:

Personal Description
Please write a few words describing your relationship with the guitar (e.g., "I've played almost every day for the last ten years, but don't perform professionally," "I play mainly to accompany my singing," etcetera:

Please tell us anything else that you would like us to know about yourself:

Release of Liability (Check "Yes" to assent. Required)
I release Kay Eskenazi, Harmony Grisman, and From Women's Hearts and Hands Guitar Camp from all liability for any injury or illness that might arise from attending From Women's Hearts and Hands Guitar Camp. I assume all risks associated with attending this Camp.
Yes.
No.

To complete the Registration process, please take the following two steps:
    1. Click the "Send" button. The form contents will be submitted to the Guitar Camp staff.
    2. Click Here to visit our Payments Page where you can pay online or find out how to pay with a check.
We will send you an email confirmation shortly after we receive this form.

 

Thank you for completing this form. We use this information to plan a curriculum and program that will address your needs and interests. We will never sell your information or share it with any other person or organization. We look forward to meeting you and studying with you at camp!