Upper Potomac Music Weekends
Fiddle Retreat Application Form

Send one form per person please!
Mail to: UPMW, PO Box 1474, Shepherdstown, WV 25443

 

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: _______________________________________ State: ______________ Zip: _____________

Phone (home): _____________________________ (work): ________________________________

E-mail: __________________________________________________________________________

I play these instruments / level: ______________________________________________________

________________________________________________________________________________

Classes Selected: List teacher preference for each time slot

Class 1: ________________________________     Class 2: ________________________________

Class 3: ________________________________     Class 4: ________________________________

*Classes will be filled on a first-come, first-served basis

Tuition and Fees

_________	Full 2 Day Workshop Session ($150) ($135 if paid in FULL by Dec. 15) or Non-refundable Deposit $25 (holds your space until Nov 15)
_________	Tuition for Saturday only ($100) ($90 if paid in FULL by Dec. 15)
_________	Tuition for Sunday only ($75) ($65 if paid in FULL by Dec. 15)
_________	Single Group class ($45)
_________	Extra Concert tickets ($15 adult, $12 senior, $8 student)
_________	Catered Lunches ($12 each) ___Saturday ___Sunday
_________	Optional Donation to the UPDF Scholarship Fund UPDF is a tax-exempt charitable organization.
_________	Grand Total Enclosed or _____ Invoice by PayPal (instructions) Make checks payabe to UPMW, and mail to address above.

Cancellation Policy:

If you cancel before December 15, we can refund all but your deposit. After January 1, we keep the entire tuition.

Students canceling after January 1 due to unavoidable circumstances may send written documentation of their reason for canceling and request a partial refund. Phone cancellations must be followed by written notice of cancellation. These requests will be considered following the end of the program.

If our entire program is cancelled due to extreme weather conditions, your entire tuition will be refunded. If we run a program, there will be no refunds available for those who didn’t come.