Urban Music Farm

Vagaband: Tom Petty & The Heartbreakers! Performance Series Registration Form Series Facilitator: Matt Taylor Series Program Director: Tom Tafelsky

Dates: (6) Wednesdays 4/16/14 5/21/14 Studio (Fremont)

First/Last Name: Mailing address:

Location: UMF

Phone: Email: Date of birth: Please tell s briefly abo t yo r m sical backgro nd and !laying e"!erience:

Please s!ecify #hich instr ment yo #ant to !lay in this $agaband session% Keyboards, Lead !hythm g"itar, !hythm #"itar, $ass g"itar, %r"ms, or Lead Voca&s' &o# did yo hear abo t this series% 'ny additional information yo (d like to share #ith s regarding yo r !ast !laying e"!erience and/or le)el of ability% Signed: Date: Payment (mo"nt: *+,-.// for the entire 01#eek series 2incl des li)e !erformance gig at a local m sic )en e3. !egistration c&oses ) *+ *)' ,"&& -ayment is d"e .ithin three .eeks of registering and is non/ref"ndab&e "n&ess series is cance&ed for any reason'
0om-&eted registration form can be emai&ed to tom1"mfseatt&e'com

45f !aying by check or money order !lease send !ayment to: Tom Tafelsky6 778 9 :lym!ic Pl ;D<6 Seattle6 9' -=77-