Jorma Kaukonen's Fur Peace Ranch: HTML Application 2008

The Fur Peace Ranch has the right to refuse any application or student, but does not discriminate based on sex, race or religion. Student/instructor ratio is approximately 10:1, or less; therefore, spaces are limited and reserved on a first come, first serve basis. Workshop spots can only be held with a deposit and a signed application. (see tuition information for application requirements). Spaces marked with asterisks must be completed.

Gift Certificates: If you are purchasing a gift certificate please fill out sections A, D, E & F only. Mail to FPR, 39495 St. Clair Rd., Pomeroy, OH 45769 or fax to 740-992-9126.

By signing the application you are entering into a legal binding contract with Fur Peace Ranch, Inc.and acknowledging that you have read and understand all of the rules, regulations and cancellation policies of the Fur Peace Ranch, Inc.

For Perfect Printing, use our PDF Order sheet located here, and mail it in.
(Adobe Acrobat PDF File, 41 KB, opens in new window)

A

2008 Student Application     Name ____________________________ Date _______________ Address _________________________ Tel # _______________ City _____________________   State ____   Zip ____________ Birthdate ____       Male ____ Female ____ Email ______________________ Name of Parent or Guardian ___________________________ (if under 18)    Tel # ____________ Business Address ___________________________________    Tel # ____________ Occupation ___________________________________________ Emergency Contact #1 ____________________________________    Tel # ____________ Emergency Contact #2 ____________________________________    Tel # ____________

B

Allergies     Yes _____      No _____ Explanation     _______________________________________________ Special Dietary Requirements     _______________________________________________ Any other medical conditions of which our staff should be made aware     _______________________________________________     _______________________________________________     _______________________________________________

C

Workshop Sessions (Indicate 1st & 2nd choice)

Indicate which weekend and instructor you are selecting for choices 1 and 2. Feb 11-15 Palm Springs ($1750) Feb 18-22 Palm Springs ($1750) Mar 7-10 ($1500) Mar 28-31 Apr 11-14 May 2-5 May 16-19 Jun 13-16 June Electric Wknd Aug 8-11 Aug 22-25 Couples Wknd Sep 12-15 Sep 19-22 Pick n Putt Wknd Oct 3-6 Oct 10-13 Oct 24-27 Special weekend! Nov 7-10 Nov Bluegrass Wknd Nov 14-17

D

Skills/Goals Information (questions are tailored for fingerstyle guitar, but answer as applicable for other instruments)

Please answer the following questions in a personal statement no longer than 400 words. What are some examples of songs you play now? (Please list no more than 4 titles) How do you play them (fingerstyle,strumming,combo,flatpick)? What are your areas of confidence and weakness? From the instructor's repertoire, what song, and what skill would you love to learn? Are you aware of, or do you utilize chord shapes or partial shapes other than first position? How would you describe your thumb independence (e.g. can you reliably alternate a bass line played against melody line?) Have you composed any originals, or would you like to explore this? What kinds of songs/music do you enjoy listening to, and would love to be able to play? (Please limit response to no more than 4 titles) Do you sing?

E

Payment Options A $185.00 deposit must accompany application. Make checks payable to Fur Peace Ranch, Inc. 39495 St. Clair Rd., Pomeroy, OH 45769 For additional information contact the Director's office, at 740-992-2575 or fax: 740-992-9126. E-mail: Workshop Fees Workshop Fee   $1,200.00 (Feb. in Palm Springs $1,750.00) (March 7-10 Weekend $1,500.00) (Couples Weekend $1,750.00) Other charges +$ $ Sub Total = $ $ Total Tuition $ $ Deposits - $185.00 Total Due $ $ Additional Charges: Equipment rental $150.00 Non student/Guest stay $195.00 (meals & Saturday concert) (see tuition page for details of charges, additional forms may be needed) ______ Check Here if making alternative lodging arrangements.

F

Payment Enclosed __ Mastercard __ Visa __ American Express __ Card # ________________________________ Exp Date ______________________________ Name on Card ________________________________ Signature ______________________________ signature for credit card only, all students sign below

G

x_______________________________________________ Applicant (Student) Signature Signature : I have read and understand the tuition guidelines, and by signing the application I understand I am entering into a legal binding contract with Fur Peace Ranch, Inc. and acknowledge that I have read and understand all of the rules, regulations and cancellation policies of the Fur Peace Ranch, Inc. Cancellation Policy: The $185.00 deposit is Non-refundable. Four weeks written notice must be given for all cancellations. We will transfer deposits and tuition amounts to another workshop for the same year only if room is available. We will refund all monies paid (less the deposit) only if 4 weeks or more notice is given. Special circumstances will be considered. Please see tuition policy on our website. _____ Check here if you would like your name added to our student carpool list. This list is available upon request.