SECTION 1

Registration Form - Winter 2012

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) on Thursday, January 26 - Registration Evening at Marianopolis
d) on Thursday, February 2 - 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: *

Student Type *

New
Returning

First Name: *

Last Name: *

Address *

City: *

Province: *

Postal Code: *

Phone (main) : *

Phone (alternate)

Courses Requested *

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
Guitar Accompaniment
Harp
Ensemble
Siamsa Singers
Set and Ceili Dancing
Irish Drama

Payment Options *

Will pay on January 26 (Registration Session Evening)
Will pay on February 2 (First Class)

Available to volunteer: *

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.