Your Details

Name

Address

City

State/Province and Postcode

Country

Phone

Email

Confirm Email

Age
Over 18
18 or under

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Dietary

Are you...
VegetarianVeganNone of the above

Any other dietary needs or restrictions

Accomodation etc

If possible, with whom would you like to share a room

Any other information we need to know?

Instrument

Please choose your class (fiddle classes are split by abilty to learn by ear, not speed of playing!):
Fiddle - Slow
Fiddle - Moderate
Fiddle - Upper Moderate
Fiddle - Fast
Cello
Piano/Guitar/Other Accompaniment
Parent/Guardian/Companion (no instrument classes included)

Payment

I wish to pay the full price of $785 now
I wish to pay a $100 deposit now, and will pay the balance of $685 before March 19th 2012

Method
I wish to pay online by credit card
I will pay by direct credit in SHISSF's New Zealand bank account
I will send a NZ$ cheque or money order payable to 'SHISSF'
I would like to pay by cheque or EFT in Australian dollars

Disclaimer

By submitting this application form, I acknowledge and agree that the organisers accept no liability for any accident, illness or damage to any persons, instruments or property whatsoever during this event; that the organisers reserve the right to cancel the event, or change instructors, classes and schedules at their discretion; and that I have read and accepted the school's cancellation policy.