Shakuhachi Summer Camp of the Rockies

Shakuhachi Summer Camp of the Rockies
Registration Form 参加申込書
Name 名前 *

First Name 名 Last Name 姓
Address 住所 *

Street Address 丁目、番号等

Street Address Line 2

City　市、町、村 State / Province 郡、県

Postal / Zip Code　〒 Country 国
Email address 　E メール *
example@example.com
Phone Number 電話番号 *

Country Code 国番号 Area Code 市外局番 Phone Number
Registration Fee ご参加費 *

$450 Super Early Bird Registration by January 31st 1月31日までの特別早割 $500 Early Bird Registration by March 31st 3月31日までの早割 $550 Registration after March 31st 4月1日以降 $200 Early Bird Absolute Beginner by March 31 初心者早割 $250 Absolute Beginner after March 31 初心者4月1日以降 $0 Scholarship applicant
SCHOLARSHIP REQUEST/SCHOLARSHIP FUND CONTRIBUTION/奨学金申請/寄付額 Scholarships enable aspiring students of need to attend camp. Any support you can offer is deeply appreciated *

I AM REQUESTING A SCHOLARSHIP $500 $250 $100 $50 $0
Describe your need and why you merit a scholarship. Scholarships will be offered to those who (1) can demonstrate financial need and who (2) will carry on the Camp's mission: the education, promotion and performance of the Shakuhachi in North America . Please address these two points in particular. Application deadline: Jan. 31, 2020 Grant announcement: Feb. 15, 2020
T-Shirt Order (Sizes-S,M,L,XL,XXL)

None One for $25 Two for $45
Payment Record (A or B) お支払記録 (A又はB)
Total Payment (US$) 　お支払総額 (US$) *
A. CHECK Check Number or (NA) 小切手番号（または”NA”） *
B. PAYPAL PayPal Transaction Number or (NA) 記録番号（または”NA”) If using PayPal, please add $15 to cover processing fees. *
C. Bank Transfer - routing number and account number will be sent to you *
Shakuhachi experience 尺八経験 *

Complete Beginner 完全な初心者 Beginner 初心者 Intermediate / Advanced 　中級・上級
Sunrise Ranch Arrival Date *

Month Day Year
Date 到着日
Sunrise Ranch Departure Date *

Month Day Year
Date 出発日
Will you attend the June 17th Pre-festival Concert in Boulder (You will be responsible for your own lodging.) ボルダー市の前夜コンサートに出席しますか？（宿泊等は自己負担です。） *

Will Attend 出席する Will Not Attend 　出席しない
Your Shakuhachi Experience　尺八歴
Style 流派 *
Genre ジャンル *
Length of Study 年数 *
Etc. 他
A short self introduction to the other "Campers" in a few sentences　参加者仲間への簡単な自己紹介
Describe yourself　自己紹介

0/600
Your Shakuhachi Life 尺八生活

0/600
Your hopes and goals for shakuhachi camp尺八サマーキャンプに対する期待、参加目的等

0/600
Individual lesson piece request 1個人レッスン希望曲名 1 *
Individual lesson request 2個人レッスン希望曲名 2 *
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Shakuhachi Summer Camp of the Rockies

Registration Form 参加申込書

Payment Record (A or B) お支払記録 (A又はB)

Your Shakuhachi Experience 尺八歴

A short self introduction to the other "Campers" in a few sentences 参加者仲間への簡単な自己紹介

Your Shakuhachi Experience　尺八歴

A short self introduction to the other "Campers" in a few sentences　参加者仲間への簡単な自己紹介