Litchfield Jazz Camp - Teach the Teacher Registration

Applicant Information:

Sex*:
First Name*:
Last Name*:
eMail*:
Address*:
Address2:
City*:
State*:	Zip*:
Country*:
Home Phone*:
Work Phone:
Cell Phone:

Emergency Contact Name:*:
Phone*:	eMail:*:

How did you hear of Teach the Teacher?*:
What are you hoping to gain from this course?*:
I would like to also attend the Litchfield Jazz Camp, and receive a $100 discount for camp:	Week 3 Week 4 Register separately for camp here.

School Name*:
Grades:
Phone:
Address:
City:
State:	Zip:

Your Primary Instrument*:
Years Played*:
Jazz Skill Level*:

Number of years teaching*:
Does your school have a Jazz Ensemble/Band?*:	Yes No
If so, what is the approximate size?:
Are you a college/Graduate Student?*:
If so, what level/year are you?:
Kent School Boarding ($75/per night)
You may reside on the night between course days at Kent School (space available) for a fee of $75/night per person double occupancy, which includes breakfast, lunch, and dinner.

Review all of the information above to ensure it is correct; once submitted it cannot be changed.
Please click the submit button only once. Submission may take several minutes.
Do not use the back button on your browser during or after submission.

Your information is kept confidential and used only for the purposes of
receiving information on the Litchfield Jazz Camp and Litchfield Jazz Festival.

Litchfield Performing Arts | P.O. Box 69, Litchfield, CT 06759 | Phone 860-361-6285 | Fax (860) 361-6288 | Contact Us