Shakuhachi Summer Camp of the Rockies
Registration Form 参加申込書
Name 名前
*
First Name 名
Last Name 姓
Address 住所
*
Street Address 丁目、番号等
Street Address Line 2
City 市 、町、村
State / Province 郡、県
Postal / Zip Code 〒
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
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Hong Kong
Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country 国
Email address E メール
*
example@example.com
Phone Number 電話番号
*
-
Country Code 国番号
-
Area Code 市外局番
Phone Number
Registration Fee ご参加費
*
$450 Super Early Bird Registration by January 31st 1月31日までの 特別早割
$500 Early Bird Registration by March 31st 3月31日までの早割
$550 Registration after March 31st 4月1日以降
$200 Early Bird Absolute Beginner by March 31 初心者早割
$250 Absolute Beginner after March 31 初心者4月1日以降
$0 Scholarship applicant
SCHOLARSHIP REQUEST/SCHOLARSHIP FUND CONTRIBUTION/奨学金申請/寄付額 Scholarships enable aspiring students of need to attend camp. Any support you can offer is deeply appreciated
*
I AM REQUESTING A SCHOLARSHIP
$500
$250
$100
$50
$0
Other
Describe your need and why you merit a scholarship. Scholarships will be offered to those who (1) can demonstrate financial need and who (2) will carry on the Camp's mission: the education, promotion and performance of the Shakuhachi in North America . Please address these two points in particular. Application deadline: Jan. 31, 2020 Grant announcement: Feb. 15, 2020
T-Shirt Order (Sizes-S,M,L,XL,XXL)
None
One for $25
Two for $45
Other
Payment Record (A or B) お支払記録 (A又はB)
Total Payment (US$) お支払総額 (US$)
*
A. CHECK Check Number or (NA) 小切手番号(または”NA”)
*
B. PAYPAL PayPal Transaction Number or (NA) 記録番号(または”NA”) If using PayPal, please add $15 to cover processing fees.
*
C. Bank Transfer - routing number and account number will be sent to you
*
Shakuhachi experience 尺八経験
*
Complete Beginner 完全な初心者
Beginner 初心者
Intermediate / Advanced 中級・上級
Sunrise Ranch Arrival Date
*
-
Month
-
Day
Year
Date 到着日
Sunrise Ranch Departure Date
*
-
Month
-
Day
Year
Date 出発日
Will you attend the June 17th Pre-festival Concert in Boulder (You will be responsible for your own lodging.) ボルダー市の前夜コンサートに出席しますか?(宿泊等は自己負担です。)
*
Will Attend 出席する
Will Not Attend 出席しない
Your Shakuhachi Experience 尺八歴
Style 流派
*
Genre ジャンル
*
Length of Study 年数
*
Etc. 他
A short self introduction to the other "Campers" in a few sentences 参加者仲間への簡単な自己紹介
Describe yourself 自己紹介
0/600
Your Shakuhachi Life 尺八生活
0/600
Your hopes and goals for shakuhachi camp尺八サマーキャンプに対する期待、参加目的等
0/600
Individual lesson piece request 1個人レッスン希望曲名 1
*
Individual lesson request 2個人レッスン希望曲名 2
*
Submit
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