MusicMASTER Workshop Registration
I wish to register for the following MusicMASTER Workshop
Date of Birth
If under 18 years of age, parental permission is required.
Please give details.
7. Payment. I am making payment by the following means. A deposit of 50% is required to secure your registration.
Credit card (details below or by phone)
Cheque payable to Loose Acoustic Enterprise
Direct Debit to BSB: 084 929 Acc Number 1366 756 99
Type of card
Name as on card
Pay with my PayPal account
If you are paying with PayPal, please send to
in PayPal and put the name of the entrant in the “email to recipient” subject. Please put your transaction number here ____________________
Payment plan details
We welcome payment by instalments. Please call 0403 124 200 if you wish to pay by this method.
Total amount paid
8. Please add me to the Loose Acoustic mailing/newsletter list
Please complete the following for
RESIDENTIAL WORKSHOPS ONLY
. Thank you.
5. Do you have any special dietary/disability needs?
6. Do you suffer from any of the following medical conditions or other conditions we should be made aware of?
High Blood Pressure
Epilepsy, fits or blackouts
A disability or chronic illness
9. In the case of an emergency, I authorise Loose Acoustic staff, where it is impractical to communicate with me, to arrangefor me to receive such medical or surgical treatment as may be deemed necessary. I also undertake to reimburse costs which may be incurred for medical attention, ambulance transport and drugs who;le I am attending the retreat. I understand Loose Acoustic and it's service providers will minimise the risk of personal injury for participants of this retreat.
10. I agree to allow Loose Acoustic to use my name and any photographs or sound and picture recordings taken of me during the retreat for the promotion of Loose Acoutic's services and initiatives to the media and general public
Build your music skills, grow your community and change your life