HarmoniCon Registration

Full Name

First

Last

Gender

Age

Participation

Participant/Student
Instructor/Staff
Parent/Guardian

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Cell Phone

Email

Confirm Email

Instrument Background

Corps and/or Re-enacting Unit(s) (if applicable)

Instrument

Years Played (if applicable)

Fife and/or Drum Teacher(s)?

Below, to the best of your knowledge, please select your Music Ability Rating for the instrument you chose above. This simply helps th instructors and speakers prepare some materials prior to the event.

Musical Ability Rating

Please select which day(s) you plan to attend HarmoniCon. Note, the entire weekend is free, regardless of how many days you attend. Please review the schedule of events on our website if you have any questions.

Days Attending

Friday, 6 November – Evening Reception, Guest Speaker and Jollification
Saturday, 7 November – full day of classes, workshops, and jollifications
Sunday, 8 November – Morning Reception, Guest Presenter (TBD), and jollification

Saturday’s lunch will be provided. If you have any dietary restrictions, please select one or more of the following, or list any food allergies under the “Medical” section further down on this registration form.

Corps Options Teacher(s)?

Meal Options

Vegetarian
Gluten Free
Other

Medical Information

Any allergies?

Any special needs or medications we should know of?

Person to contact in case of emergency

Name

Relationship

Phone

Photo Release

I give permission for photos, video, and/or recordings of my participation at HarmoniCon to be published or used in promotional materials or publicity for HarmoniCon and the Field Music School. I understand that no royalty or compensation will be due me if any photo, video, or recording in which I appear is used for any purpose.

I hearby consent to the use of visual images taken of me at the Jamestown Settlement or the American Revolution Museum at Yorktown by the Commonwealth of Virginia, The Jamestown-Yorktown Foundation, the Jamestown-Yorktown Educational Trust, or the officers, successors, assigns, or licensees of any of those entities, for the purpose of trade or advertising, promoting, recording, offering the benefits of, or teaching about the facilities or services of the Commonwealth of Virginia, Jamestown-Yorktown Foundation or Jamestown-Yorktown Educational Trust, including but not limited to Jamestown Settlement and the American Revolution Museum at Yorktown.

I need not inspect or approve the finished product or the advertising or other copy that may be used in connection therewith or the use to which it may be applied.

Yes, I agree