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Registration


Name: ______________________________________________________

Address:  ________________________________________________

                  ________________________________________________

Phone:      _______________________

E-mail:      _______________________

Credit Card Number (if paying by credit card):__________________________

Type of Card:  __ Visa  __ Mastercard  __ Discover

Card Expiration Date:  ____________


Classes: Check the box for the section you wish to attend in each time slot.

9:00 a.m.
Beginning Piping___     Intermediate Section I ___   Intermediate Section II ___


1:00 p.m.
Reed Making and Pipe Maintenance ___       Advanced Piping ___

3:00 p.m.
Mick O'Brien Master Class ___

7:00 p.m.
Mighty Session and General Piping Melee ___

Registration Fee - $60.00.  Note: For the first time, we are able to offer credit card payments for your registration.  Simply fill out the form, with a credit card number (Visa, Master Card or Discover) in the space provided, and paste it into an e-mail.  Send the e-mail to jwgaffney@hotmail.com.  If you don't want to e-mail your credit card number, you can fax the form to John at (815) 943-7916.  Otherwise, just send a check or money order payable to John Gaffney to:

John W. Gaffney
103 West Sumner Street
Harvard, Illinois  60033

Any questions or concerns, just e-mail John at jwgaffney@hotmail.com or Bob Kellam at KELLAMR@BCBSIL.COM.  Otherwise you can contact John at his office at (815) 943-0900!