JAM Registration Form
JAM Location
*
Sullivan County (Sullivan Central Middle School)
Johnson City/Washington County (Ashley Academy)
University School (ETSU-Alexander Hall)
Student Name
*
First Name
Last Name
Parent / Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Email
*
example@example.com
Parent Mobile Number
*
-
Area Code
Phone Number
Alternate Phone Number
*
-
Area Code
Phone Number
Student Grade This Year
*
4th
5th
6th
7th
8th
9th
10th
11th
12th
Preferred Instrument (first choice)
*
Old-time banjo
Bluegrass banjo
Fiddle
Mandolin
Guitar
Bass
Song
Preferred Instrument (second choice)
*
Old-time banjo
Bluegrass banjo
Fiddle
Mandolin
Guitar
Bass
Song
Student Level of Experience
Novice (just starting)
Lower Intermediate (at least 6 months playing; still needing technical help)
Upper Intermediate (2 years playing - can play pretty well)
Advanced (playing for several years; can play a dozen tunes or more)
Do you need to borrow an instrument for JAM? (please note there is limited availability - first come, first served)
Registration
Sullivan County (Open to Community); 4-12 grades: $150
Johnson City/Washington County (Open to Community; 4-12 grades): $150
University School (UH Students only; 4-12 grades): $150
Other Amount (check this box with special permission only)
JAM Payment: Enter amount from above:
*
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