Fillable Bolsover Brass Summer School Residential Sunday 23 July (Shirebrook Town Council)

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Bolsover Brass Summer School Residential Sunday 23 July (Shirebrook Town Council)

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Bolsover Brass Summer School Residential
Sunday 23 July – Friday 28 July 2017
Enrolment Form
Personal Details:
Full Name: …………………………………………………………………................................................
Your home address, including postcode: ……………………….......……………..........…………………
…………………………………………………………………………………………………………………
Telephone Number Day: …………..….….. Evening: …………...…….. Mobile: ……………...…...
Email Address: ……………………………………………………………................................................
Date of Birth: ……………………………..
Participants under 16 years of age must be accompanied by an adult if attending as a “residential
attendee”.
Any special requirements (disabilities / dietary requirements etc.)
……………………………………………………....................………………………………………..........
Any medical conditions
……………………………………………………....................………………………………………..........
Gender: M / F
Instrument you play: ................................................………………………………………………………
Standard/ Grade: ….......................................................……………………………………………………
Band you currently play with or most recent position: …………...........…………………………………
……………………………………………...............................................................................................
T-shirt size: ………………………………..
B
OLSOVER
Brass Summer School
Gender
Payment:
Please tick all that apply:
Residential all inclusive rate - £475 per person
If applicable to you, which other summer school attendee would you wish to share your room with?
Name: ................................................………………………………………………………………………
Non residential rate - £325 per person
Non participating guests - £325 per person
Single person supplement - £125
Junior Brass Player & Percussion - £20
Brass for Beginners - £10
Total cost of Summer School course £…..............
Please enclose a non refundable £100 per person deposit to conrm your booking making cheques
payable to Shirebrook Town Council, and post completed form to:
Carole Hirst,
Shirebrook Town Council,
54 Patchwork Row,
Shirebrook,
Manseld,
Notts.
NG20 8AL
mob: 07903 377066
email: carolejcrompton@btinternet.com
Payment
Please let us know how you heard about the BBSS.
Please tick those that apply:
4 Bars Rest Website
BBSS Tutor, please specify who …………………………….
BDC Council Website
Facebook – Bolsover Summer School
Other, please specify ………………………………………..
Whilst all of the above information is correct at time of going to print, the Council reserves the right to make any
changes necessary should the necessity arise.
All personal information provided to Shirebrook Town Council will be held and treated in
condence in accordance with the Data Protection Act 1998. It will only be used for the
purpose for which it was given.
Designed by Bolsover District Council 7633
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Bolsover Brass Summer School Residential Sunday 23 July (Shirebrook Town Council)

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Completed 30 July 2020

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