Bluegrass in the Park 2005

A festival for Musicians – August 5, 6, 7

Performer Entry Form

Please print or type clearly and read carefully before signing. Return entire form with entry fee to: Walter Bungard, 11979 C.R. 487, Atlanta Michigan 49709. Check or Money Order payable to: Walter Bungard or fax Entry Form and Visa/MC info to (989) 785-5126. Early entry due by July 15, 2005. Entry at Festival - Cash Only.

Name: _________________________________________________

Address: _________________________________________________

_________________________________________________

Email: _________________________________________________ phone: __________________

** Keyboard accompaniment will be available. Must provide a sheet with music and chords for keyboardist. **

Age Division (Please check one only):

___ Youth up to 13 yrs of age

___ Teen 14-18 yrs of age

___ Adult 19 yrs of age and older

Category (Please check all categories you are entering):

___ Guitar ___ Banjo ___ Fiddle ___ Mandolin ___ Band Competition

Entry Fee Enclosed:

___ Youth: $5.00 per category entered. Total __________

___ Teen/Adult: $10.00 per category entered. Total __________

___ Band: $25.00 per group. Total __________

Check or Money Order payable to Walter Bungard, or

Visa/MC # __________________________________________ exp ___________________

Signature __________________________________________________________________

Release or Liability:

The Township of Briley, Atlanta Area Chamber of Commerce, Walter Bungard, Luanne Bungard and/or any of their agents or sponsors are not responsible for loss of belongings, damage to properties or liable for any injury incurred during the festival. I agree and hold harmless any of the above persons/entities in the event of injury or loss/damage of possessions.

Signature: __________________________________________________________________________

(parent or guardian if minor)