SECTION 1

Registration Form - Winter 2010

You may submit your registration for our Winter classes online using the form below.

After submitting your application, we will contact you by e-mail to confirm your registration and provide the total required for payment. This will include any rebates for multiple course combinations that you may have selected.

Our payment options include:
a) in person on Thursday, January 28, at Wesley United Church
d) in person on Thursday, February 4 - evening of the first class

You will need to indicate your preference by answering the questions in the form below.

If you have any problems with the form, please get in touch with Denis at 450-479-6725 or by e-mail at info@siamsa.org

E-mail Address: *

Are you a New or Returning Student ? *
New Returning
First Name: *

Last Name: *

Address: *

City: *

Province: *

Postal Code: *

Phone (main) : *

Phone (alternate):

Courses Requested: *
Introduction to Traditional Music Fiddle Beginner Fiddle Intermediate Fiddle Advanced Tin Whistle Beginner Tin Whistle Intermediate Tin Whistle Advanced Bodhran Beginner Bodhran Intermediate Flute Beginner Flute Intermediate/Advanced Button Accordion Mandolin Beginner Ensemble Performance Guitar Set and Ceili Dancing Singing Irish Drama
Payment Options: *
Will pay on January 28 (Registration Session Evening) Will pay on February 4 (First Class)
Would you be able to volunteer time for Siamsa activities ? *
Yes No
Accept inclusion in Siamsa publicity activity: *
Yes No
Questions or Comments:



* Required

After pressing the Submit button you will receive by e-mail a copy of the information that you are submitting. We will follow-up and send you a second e-mail to confirm your registration and final total for payment.