Ludiker Fiddle Camp Registration:

Address: ________________________________

City/State/Zip: ___________________________

Age: _______________ M / F

Parent/Gaurdian: ________________________

E mail: _________________________________

Instrument (circle one)
Fiddle	Guitar	Mandolin	Keyboard	Bass

Please enclose your $175 deposit (check or money order) or complete the charge card information below:

Amount of enclosed check, or charge my card $ __________

Visa / Master Card (circle one)

#________/________/________/________ exp.____/____

Name on card:__________________________

Or register by phone - call 1-509-927-7529

Please Send Payment and Registration to:

JayDean Ludiker
1408 N. Vista Rd.
Spokane, WA 99212-2520