July 24-28, 2023
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Mountain Music School Online Application 2023
Registration is open for the 2023 Mountain Music School
Payments can be mailed to: Workforce Solutions 3441 Mountain Empire Rd, Big Stone Gap, VA 24219
Attn: Lori Dingus or Caitlin Mullins
Date:
*
MM slash DD slash YYYY
Name
*
First Name
Last Name
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone:
*
Email
Age of Participant (All youth participants must be ages 10-17):
*
10
11
12
13
14
15
16
17
Adult
Participant Date of Birth
*
MM slash DD slash YYYY
Diet Restrictions (Please list any specific diet restrictions):
*
None
Class Preference - Choose one only (experience means weekly practice):
*
Beginning Autoharp (no - little experience)
Intermediate Autoharp (2-3 years experience)
Ukulele
Beginning Clawhammer Banjo (no - little experience)
Intermediate Clawhammer Banjo (2-3 years experience)
Advanced Clawhammer Banjo (4-5 years experience)
Beginning Doghouse Bass (no - little experience)
Intermediate Doghouse Bass (2-3 years experience)
Beginning Dulcimer (no - little experience)
Intermediate Dulcimer (2-3 years experience)
Beginning Fiddle (no - little experience)
Intermediate Fiddle (2-3 years experience)
Advanced Fiddle (4-5 years experiences)
Intermediate Guitar (2-3 years experience)
Beginning Guitar
Advanced Guitar (4-5 years experience)
Beginning Mandolin (no - little experience)
Intermediate Mandolin (2-3 years experience)
String Band (4+ years experience)
Vocal/Singing (no - little experience)
Beginning Bluegrass Banjo ( No - little experience. Class is limitd to 12 students)
Loaner Instruments - $25 DEPOSIT REQUIRED IN ADDITION TO REGISTRATION FEE
(instrument deposits will be refunded on the last day of Mountain Music School when instrument is returned in same physical condition as loaned)
I wish to apply for a "Loaner" instrument to use for the week and understand that I will be financially responsible for any damage to the instrument or not returning instrument:
*
I do not wish to apply for a "Loaner" instrument
Autoharp (add $25 deposit to registration fee)
Banjo (add $25 deposit to registration fee)
Bass (add $25 deposit to registration fee)
Dulcimer (add $25 deposit to registration fee)
Fiddle (add $25 deposit to registration fee)
Guitar (add $25 deposit to registration fee)
Mandolin (add $25 deposit to registration fee)
T-Shirt Size - Choose one only:
*
ADULT S
ADULT M
ADULT L
ADULT XL
ADULT XXL
ADULT XXXL
ADULT XXXXL
YOUTH S
YOUTH M
YOUTH L
YOUTH XL
Please note, the registration fee may be paid the first day of registration.
Registration Fees
*
Students 10 - 17 years of age: $50.00 per student (ADD $25 FOR ANY LOANER INSTRUMENT REQUESTS)
Students 18 and older - $150.00 per student (ADD $25 FOR ANY LOANER INSTRUMENT REQUESTS)
Parent(s) for students 10-17, please enter your name below (adult participants please specify N/A):
*
Parent(s) for students 10-17, please enter your driver's license number below (adult participants please specify N/A):
*
Parent's address, if different from student (or specify N/A):
*
Parent's telephone number for emergency (or specify N/A):
*
Consent
I agree to the privacy policy.
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