EmailMe Form - HILLBILLY MUSIC IN THE HILLS

Which Retreat would you like to apply for?

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone Number *

### - ### - ####

Tell Us A Little About Yourself

Who are you as a writer/artist? *

Why do you want to attend the weekend? *

Do you play an instrument? *

If Yes, please describe:

Which would you say best describes your writing strength? *

Melody

Lyric

Both

Are you comfortable co-writing? *

Please give us THREE examples of your best songs.

Song Title 1 *

Link: *

Song Title 2 *

Link: *

Song Title 3 *

Link: *

CARD TYPE

Credit Card #

EXP DATE (mmyy)

SECURITY CODE