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WRW 2012
Online Application Form
NOTE: To avoid incomplete forms being sent to us accidentally, we have made all text areas "required" fields. This means
you must put something in each space, even if you just type "none". Otherwise, you'll get an error message.
PARTICIPANT INFORMATION
Name:
Home address:
City:
 Postal Code:
Home phone:
 Work phone:
Cell phone:
Email address (one that you check frequently):
Which is the best way to contact you?
INSTRUMENT CHOICES
Please indicate a first and second choice of instrument. We do our best to give everyone their first choice, but we need to
have a balance of instruments to make bands and instrument instruction run smoothly.
First choice?
Electric guitar
 Electric bass
 Keyboards
 Drums
How would you rate your familiarity with this instrument?
Never tried it
 Know the basics
 Currently learning
 Quite comfortable
Second choice?
Electric guitar
 Electric bass
 Keyboards
 Drums
How would you rate your familiarity with this instrument?
Never tried it
 Know the basics
 Currently learning
 Quite comfortable
Will you be bringing your own instrument to camp? (It's not necessary, but you may if you like AT YOUR OWN RISK.)
No
 Yes
 If yes, what instrument will you be bringing?
Do you require a left-handed instrument?
 Yes
 No
SAFETY INFORMATION
Please let us know about any medical conditions, allergies or medications that our staff should be aware of:
EMERGENCY CONTACT
Contact name:
 Contact phone:
Relationship to you:
WHO ARE YOU, REALLY?
We'd love to know more about you! Please give us a brief description of your interest in music and what you hope to get out
of the weekend.
PUBLICITY WAIVER
I give permission to RC4G Peterborough to use photos, video or sound recordings of me for documentation or
promotional purposes.
I DO NOT give permission to RC4G Peterborough to use photos, video or sound recordings of me for documentation
or promotional purposes.
ADDITIONAL DONATION
Would you be willing to make an additional donation to support RC4G's camper subsidy or equipment funds? (The
amount can be added to your deposit cheque or to your balance paid on the first day of camp.)
$10
 $25
 $50
 $100
 Other
NEED MORE INFORMATION?
If you need more information or have questions, let us know. We'll get back to you as quickly as possible. (Or call us at
705-748-4987.)
Women's Rock Weekend
a weekend rock n' roll retreat
for women aged 19 to 99
WOMEN'S ROCK WEEKEND 2012 -- OCTOBER 20 & 21

Always had a secret dream to play in a rock ' n roll band? Have a hankering to try
meet a bunch of other women who like to rock? Join us Oct. 20 & 21, 2012,
for Women's Rock Weekend, our crash course in rock 'n roll for women. To apply
just scroll down to our online application form.

Women's Rock Weekend is an intensive and fun-filled introduction to the basics of
rock for women of all ages. Participants get instruction on the instrument of their
choice (electric guitar, bass, keyboards or drums), learn new skills in a variety of
workshops, practice together with other women as part of a band, and then show
off their new skills at a final showcase called the Big Gig. The $250 registration
fee includes all equipment, meals and snacks, and a Saturday evening party. Not
only is the weekend a lot of fun, it's also RC4G's most important fundraiser for
our summer programs for girls - all proceeds go to camper subsidies and our
equipment fund.

Check out photos of WRW 2009 and videos of the bands' performances.

Never played before? No worries. Previous musical experience is NOT a
pre-requisite - WRW is all about trying something new. You do not have to bring
your own instrument - we supply all gear. (If you have an instrument you'd like
to bring, you certainly may.)
WRW starts at 9:00 a.m. sharp on Saturday morning and runs all day Saturday and Sunday, including a Saturday
night party. The weekend wraps up with the BIG GIG at 5:00 pm on Sunday. A detailed schedule will be sent to all
applicants.

To apply, complete the online form below. The cost of WRW 2012 is $250. (A great deal! -- we've rock 'n rolled our
prices back to 2009 rates so more women can attend. Please let us know if you would like to make an additional
donation.) We require a $50 deposit to secure your spot (refundable up to Oct. 1). Your deposit should be payable
to RC4G Peterborough and can be mailed or dropped off to:

RC4G Peterborough
762 Armour Rd.
Peterborough, ON  K9H 2A1

The balance can be paid on the first day of WRW.

Still have questions? Email us at rc4g@sympatico.ca or call 705-748-4987.