Holiday Lake 4-H Educational Center

Banjo Workshop Registration
April 17-21, 2011

Banjo Workshop
Full Name
First Name Last Name
E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
Sex

Male Female
Should be Empty:

Mail Check to:
Holiday Lake 4H Educational Center
1267 4-H Camp Road
Appomattox, VA 24522

Please register by: Sept. 17, 2010

Full: by Sept 17, 2010
50% : after Sept 17, 2010
Nonrefundable after Sept. 24, 2010

If you are a person with a disability and desire any assistive devices, services or other accommodations to participate in the Workshop, please contact The 4-H Center no later than two weeks prior to the date assistance is needed between the hours of 8:00 a.m. - 4:30 p.m. Monday through Friday.

Holiday Lake 4-H Educational Center programs and employment are open to all, regardless of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. An equal opportunity/affirmative action employer.

Banjo Workshop Registration April 17-21, 2011

Banjo Workshop

Banjo Workshop Registration
April 17-21, 2011