Summer Jembe Institute,
School of Music, UNCG, P.O. Box 26167,
Greensboro, NC 27402-6167
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.