Registration Form
Summer Jembe Institute June 8 - 13, 1998
Print this via your WWW Browser and Mail or Fax Registration Form to:
Summer Jembe Institute, School of Music, UNCG, P.O. Box 26167, Greensboro, NC 27402-6167
FAX: 336.334.5497 

Name: ___________________________________________________

Home/Street Address: ______________________________________________

City: _________________________________ State: ________  Zip: ____________

Home Phone: (_____)______________    Work Phone: (_____)_______________

E-mail Address: ______________________________________

Check if we may include your [ ] address, [ ] telephone, and [ ] e-mail 
in our class list to be distributed to institute participants.

CHECK YOUR PRIMARY INTEREST (or number your preferences):
   [ ] I am interested in jembe instruction
          Rate your own playing level and the learning pace you prefer:
          [ ] Beginning (0-1 year experience);     [ ] slow, [ ] average, [ ] fast.
          [ ] Intermediate (1-5 years experience); [ ] slow, [ ] average, [ ] fast.
          [ ] Advanced (5+ years experience);      [ ] slow, [ ] average, [ ] fast.
   [ ] I am interested in dundun instruction
   [ ] I am interested in dance instruction
   [ ] I am interested in balafon instruction

TUITION (check appropriate box; does not include room and board):
        Early Bird Special!  [ ]  received by April 10          $325
                             [ ]  received April 10 - April 30  $350
                             [ ]  received May 1 - May 31       $375
        Late                 [ ]  received June 1 or later      $400

PARKING STICKER (highly recommended for those driving):
        [ ]  $10 for a 1-week permit

REFUND POLICY:  Cancellations and refund requests must be made in writing by May 25
in order to receive tuition reimbursement. A $25 processing fee will be deducted
from the reimbursement.

ROOM AND BOARD arrangements must be made directly with the UNCG 
Division of Continual Learning (see front of brochure for address). 

[ ] Check enclosed (payable to: UNCG)           [ ] VISA        [ ] MasterCard
(Credit card users: add $3.00 processing fee; May 25 is last date to use cards.)

TOTAL AMOUNT ENCLOSED:  $______________  

Card #: _____________________________________  Exp. Date: _______

Cardholder's Name:  ____________________________________________ 	

Cardholder's Signature: ________________________________________	

Cardholder's Address:	________________________________________

Neither UNCG nor Talking Drums Inc. may be held liable for any injuries,
losses, or damages to the participants or their property.