Great Basin Jazz Camp 2008 Application

July 14^th – July 18^th 2008

Northwest Nazarene University

Nampa, Idaho

Name_____________________________________________________________

Address___________________________________________________________

City_____________________________________________________State___________Zip_______________

Home Phone____________________Cell________________________

Main Instrument or Vocal (Pick One)_________________Other Instruments played__________________________________________________________

Age_______(MUST BE LEAST 15)

Date of Birth____________________________

In Case of Emergency, Contact_______________________________________________________________________

Relationship______________________Home Phone_____________________ 

Work Phone__________________________

Cell Phone____________________________   

E- Mail_______________________________

Medical or Health Insurance__________________________________________________________

Policy Holder's Name____________________________________Policy #_____

Medications or Allergies?___________________________________Explain__________________________________________________

REFERRED BY_____________________________________________________________________

(By making Application, you will give faculty and staff permission to secure proper medical care in the event of a medical emergency)

=======================================================

APPLICATION – PAGE 2 - GREAT BASIN JAZZ CAMP 2008

Great Basin Jazz Camp

July 14^th – July 18^th 2008

Northwest Nazarene University

Nampa, Idaho

Please indicate which Plan you wish to use to ensure your student-musician's enrollment at the Great Basin Jazz Camp 2008. Please choose Plan from the “TUITION” page on Camp website.

Plan # ____

By your signature to the Application, you understand and agree to the conditions stated in the Addendum.

Parent___________________________________________________________Date_______________________________

These forms can be sent by email. Or you can print out, fill in all all requested information and send with your personal check or money order. Make checks/money orders payable to 'GREAT BASIN JAZZ CAMP'. A $100.00 NON-REFUNDABLE DEPOSIT MUST ACCOMPANY YOUR APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.

MAIL COMPLETED APPLICATION TO: GREAT BASIN JAZZ CAMP – 1346 IDAHO STREET, SUITE 143, ELKO, NV 89801. When using 'PayPal' simply use our email address. In the message box, PLEASE state name of your student for bookkeeping purposes. Our system is set up to recognize student names. Otherwise, there may be a delay in processing your application. Questions? Please contact us at info@greatbasinjazzcamp.com for an immediate reply.

REGISTRATION ENDS JUNE 15TH, 2008.

DON'T BE DISAPPOINTED.  ENROLL NOW! 

APPLICATIONS ARRIVING AFTER JUNE 15TH, 2008 CANNOT BE ACCEPTED.

Great Basin Jazz Camp is a certified Nevada and Idaho Non-Profit Corporation. Federal 501 C (3) Non Exempt Tax status approved 1/17/2008. Proof upon request.