Jorma Kaukonen's Fur Peace Ranch: HTML Application 2009

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 spaces can only be held with a deposit and a signed application. (see tuition information for application requirements).

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

2009 Student Application     Name _______________________________ Date _______________ Address ____________________________________________ City _____________________   State ____   Zip ____________ Telephone _________________________   Cell______________________ Email _______________________________________ Birthdate _______       Male ____ Female ____ Country__________________ Name of Parent or Guardian ___________________________ (if under 18)    Tel # ____________    Cell # ____________ Business Address ___________________________________    Tel # ____________ Occupation ___________________________________________ Emergency Contact #1 ____________________________________    Tel # ____________ Emergency Contact #2 ____________________________________    Tel # ____________

B

Allergies     Yes _____      No _____ Explanation/Medications     _______________________________________________ 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. January 12-16 Miracle Hot Springs ($1750) January 19-23 Miracle Hot Springs ($1750) March 13-16   March 27-30 April 3-6 April 17-20 Special May 1-4 May 15-18 May 29 - June 1 June 12-15 Jun 30-Jul 3 Full Moon Resort ($1750) July 6-10 Full Moon Resort ($1750) August 14-17 Couples Weekend August 28-31 September 11-14 Pick and Putt October 2-5 Special October 16-19 Reverend Tribute October 30 - Nov. 2   November 13-16

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? How did you hear about the Fur Peace Ranch? (i.e. friend, magazine, web, other?)

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   (January Miracle Hot Springs $1,750.00) (July Full Moon Resort $1,750.00) Other charges +$ $ Sub Total = $ $ Total Tuition $ $ Deposits - $185.00 Total Due $ $ Additional Charges: Equipment rental $150.00 Non student/Guest stay $195.00 (meals & Saturday concert) Name of Guest__________________________________________ (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 ____ Gift Certificate ____ Card # _______________________________________________ Exp Date _____________________________________________ Name on Card _________________________________________ Signature _______________________________________Date______________ Signature for credit card only, all students must sign below An original copy of your gift certificate must accompany this application

G

x_________________________________________Date_____________ 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.