Standard / Octave Mandolin Building Workshop Registration Form

Registration Deadline: March 16th, 2007

Name________________________________________________________

Address ______________________________________________________

Phone________________________________________________________

E-mail _______________________________________________________

Male_____ Female______

I would like to build:

Standard Mandolin _____

Octave Mandolin    _____

Cost: $ 575.00 (Standard Mandolin)

          $ 625.00 (Octave Mandolin)

              ***(note: $225.00 due to Holiday Lake 4-H Educational Center at time of registration deadline)

              (Remaining $350.00 or $400.00 will be due at time of workshop and payable to Don Kawalek)

Amount Enclosed $________________

How did you learn of this  workshop? __________________________________________________________

Make Check of $225.00 Payable & Mail registration form to:

Holiday Lake 4-H Educational Center

1267 4-H Camp Road

Appomattox, VA 24522

-------------------------------------------------------------------------------------------------------------------------------------

Cut and save for your information

Standard Mandolin Building Workshop

Refund Policy

Full: by March 16th, 2007

50% : after March 16th, 2007

Nonrefundable after March 23rd, 2007

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.