• First Name: ***
• Last Name: ***
• Street Address: ***
• City: ***
• State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia 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 Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ***
• Zip: ***
• Birth Date: - Month - January Febuary March April May June July August September October November December - Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Year - 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 ***

• First Name: ***
• Last Name: ***
• Primary Phone: - - ***
• Work Phone: - -
• Cell Phone: - -
• Email: ***

• First Name:
• Last Name:
• Primary Phone: - -
• Work Phone: - -
• Cell Phone: - -
• Email:

• First Name: ***
• Last Name: ***
• Phone: - - ***
• Relation: ***

• Have you had any music lessons before? How many years? ***
• Have you ever been in a band or performed on stage? ***
• Favorite band and song? ***
• How did you find out about Summer of Rock? ***
• Any additional info that might help us place you?

Minimum deposit of $150.00 included with this filled out registration is required to hold a spot. Remainder of balance is due by May 15th to receive the discounted price. If payment is not made in full by May 15th the remainder is due by the first day of camp and the total price will be $300.00 (or $250.00 with band-discount). All sessions are first come first serve, payment of deposit will hold spot, please read cancellation policy. Checks made payable to: Tangled Tones Music Studio (TTMS)

All registrations include: a practice CD, Self Made CD (individual songs & band recordings) at camp, Camp T-shirt, one day of pizza lunch, community performance and most importantly a week of rockin’ and learning!