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___________________                          Division_________________________________

CONNECTICUT AUDUBON SOCIETY

CENTER AT GLASTONBURY

1361 Main Street, Glastonbury, CT  06033

860-633-8402

REGISTRATION –FIDDLE CONTEST

Print Name  ___________________________________________________

Mailing Address  _______________________________________________

City  _____________________________  State  ______  Zip ___________

Phone Number(s)  ______________________________________________

Age  ______  Parent’s Name (if minor)  _____________________________

E-mail  _______________________________________________________

Division:  (please circle) Open, Senior, Young Junior, Older Junior, T&F

                                                          (19-59)     (60+)         (under 12)                (12-18)                (all ages)

By signing this form, I agree to the rules and allow Connecticut Audubon to record and photograph my performances that may be used for promotional purposes.

_____________________________________________________________

Fiddler’s Signature   (Parent’s signature if fiddler under 18)

TUNES YOU WILL BE PLAYING:

            (Waltz)

1.  ___________________________________________________________

            (Tune of choice)

2.  ___________________________________________________________

            (Hoedown)

3.  ___________________________________________________________

Thank you for joining us for a great day!