Event Registration Form

Paradise Coast Harmonica Workshop Event Registration Form
Event Information

Three days and nights of seminars, jam time and more!
Attendee Information

Please fill in your name and contact information.
Your Name

PrefixFirst NameLast Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
What are your harmonica goals?

What topics would you like to see coverd?

Do you like to visit jam nights? Please leave comments/suggestions in the dialouge box below.

Payment options:

$325 deduct $12 by using paypal.me/geraldfierro friends and family, or

Venmo @Jerry-Fierro-1 or by mailing a check 9934 Via San Marco loop Fort Myers, FL 33905

Single day $125. PLEASE PAY AT TIME OF REGISTRATION (it helps greatly)

After submitting this form, go to www.jerryfierro.com and hit the PCH Workshop tab, there you can scan the QR code of your choice for payment (please use friends and family) or you can contact me for more payment options. Thank you for choosing to join us for this exciting event.
comments or questions
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