Jorma Kaukonen's Fur Peace Ranch - 2008 Online Application

Jorma Kaukonen's Fur Peace Ranch:2008 Online Application

FPR Sign 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.

Important!

Someone will contact you by telephone ONLY if there are questions or registration problems. You will receive a confirmation of your registration as well as an invoice and student booklet. We try our best to be gentle with our planet's resources. With this in mind, we will e-mail these items to you (whenever possible) rather than the paper and postal route.

By submitting 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.

Section A: Personal Information (2008 Application Form)

*Name (first):

*Name (last):

*Street Address:

*City:

*State:

*Zip Code:

*Country:

Other Country:

*Birthday: (Ex: 4/5/69)

*Gender:

*Phone Number:

*Cell Phone Number:

*Email Address:

Name of Parent or Guardian (if under 18)

Parent/ Guardian Phone Number:

Business Address:

Occupation:

*Emergency Contact Name:

*Emergency Contact Phone Number:

*Emergency Contact (2) Name:

*Emergency Contact (2) Phone Number:

*Have you attended the Ranch before?

Section B: Medical Information

*Allergies:

Yes No

*Explanation/Medicines:

*Special Dietary Requirements:

*Any other medical conditions of which our staff should be made aware:

Section C: Workshop Information
(If you are requesting a workshop with an instructor for the first time, please refer to the Levels described at http://www.furpeaceranch.com/schedule-requirements.html If you are unsure, or have questions about placement, please contact our educational consultant Marjorie Thompson at )

* 1st Choice of Weekend:

* Instructor/Class:

* 2nd Choice of Weekend:

* Instructor/Class:

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

* Please answer the following questions, keeping replies brief (1-2 sentences.)

Section E: Payment Information

If you'd like to pay by check, then you cannot apply online. You must apply via the U.S. mail only. Printable forms are available HERE. We cannot reserve your space without deposit payment.

We will charge your card manually, only when your placement in the class you have chosen is secure. We will charge your card a $185.00, non refundable deposit, as well as the following additional optional charges:

Total:

Do you have an additional Guest?
($195.00 extra includes meals and the concert on Saturday. Note for couples weekend: You do not need to click "yes" here for your better half." )

Yes No

*Name of Guest:

Are you making alternative lodging arrangements?

Yes No

Equipment Rental: ($150.00 extra charge)

Yes No

Payment Type:

Name on Card:

Credit Card #: (no spaces, no dashes)

Expiration Date: (Ex: 06/09)

Section F: Approval/ Confirmation:

By Checking the YES box, this acts as an official signature. Do you approve this request?

Yes No

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.

Misc.

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 the box if you would like your name added to our student carpool list. This list is available upon request.

Yes No