Name:

 Major Instrument: 

 Other Instruments:

 Grade in School Next Fall: 

 Parent’s Name:

 Address:

 City:   State:     Zip:     

 Camper email:

 Parent email:

 Home phone number:

 Cell phone number:

 Band Director:

 Directors email if possible:

 School Name:

 School Address:

 City:   State:   Zip: 

 Please select one:

  I need room and board at camp                I am going to commute to camp

 Please select one:

  I am a returning camper                              I am a new camper

 I received the following award     at this event

 Please reserve the following t-shirt size (Adults sizes):      Please select one Small Medium Large XLarge XXLarge XXXLarge

Please mail your $50.00 deposit to:

Carol Ayres, Jazz Camp
Iowa Lakes Community College
300 S. 18th Street
Estherville, IA  51334