PLEASE PRINT THIS APPLICATION FORM.

• Please complete the application below and mail it along with your deposit of $400.00 by June 13, 2008 to Hope & Bob Pettegrew, 117 Middle Road, Hancock, NH 03449.
• All checks should be made payable to Piano'Scape.
• The balance of the fees will be due no later than July 25, 2008.

Cancellations received after July 14 will forfeit the deposit.

Please Print

Name___________________________________________________________________________
Address_________________________________________________________________________
Home Phone_____________________________________ Work Phone _____________________
E-mail_________________________________________Occupation ________________________
Do you have special dietary requests?________________________________________________
Do you have a teacher now?_____________
What are you currently studying?____________________________________________________
________________________________________________________________________________
How long have you been working on this/these peice(s)?_________________________________
Do you wish to study Classical, Jazz, or Swing (any combo)?_____________________________
Describe your skill level:__________________________________________________________
Is it at the performance or study level?________________________________________________
What are your goals for the week?__________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Are there specific topics of particular interest to you (in Classical, Jazz or Swing)
that you want to hear/learn about?________________________________________________
_________________________________________________________________________________

Approximate time of arrival on registration day: Aug. 16 ^th________________
( ) Do you prefer a single room?
( ) Do you prefer to share a room with another Piano'Scape student?
( ) Do you plan to share a room with a non-student ?

Deposit Amount Enclosed: $________

Signature__________________________________________Date_________________

Reservations are limited. Please complete and return this form at your earliest convenience along with your deposit.

For More information, call Hope and Bob Pettegrew at (603) 525-4920 or email us at

Piano 'Scape

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