Upper Potomac Music Weekends
Fiddle Retreat Application Form

Send one form per person please!
Mail to: UPMW, PO Box 1474, Shepherdstown, WV 25443


Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: _______________________________________ State: ______________ Zip: _____________

Phone (home): _____________________________ (work): ________________________________

E-mail: __________________________________________________________________________

I play these instruments / level: ______________________________________________________


Classes Selected: List teacher preference for each time slot

Class 1: ________________________________     Class 2: ________________________________

Class 3: ________________________________     Class 4: ________________________________

*Classes will be filled on a first-come, first-served basis

Tuition and Fees


Full 2 Day Workshop Session ($185)

($160 if paid in FULL by Dec. 1) or
Non-refundable Deposit $25 (holds your space until Dec 15)


Tuition for Saturday only ($110)

($90 if paid in FULL by Dec. 1)


Tuition for Sunday only ($85)

($70 if paid in FULL by Dec. 1)

_________ Single Group class ($45)

Extra Concert tickets

($20 adult, $18 senior, $10 student)

_________ Catered Lunches ($15 each) ___Saturday

Optional Donation to the UPDF Scholarship Fund

UPDF is a tax-exempt charitable organization.


Grand Total Enclosed

Make checks payabe to UPMW, and mail to address above.

_________ Payment by PayPal (instructions)

Cancellation Policy:

If you cancel before December 1, we can refund all but your deposit. After January 1, tuition is non-refundable.

Students canceling after December 15 due to unavoidable circumstances may send written documentation of their reason for cancelling and request a partial refund. Phone cancellations must be followed by written notice of cancellation. These requests will be considered following the end of the program.

If our entire program is cancelled due to extreme weather conditions, your entire tuition will be refunded.

If we run a program, there will be no refunds available for those who don’t come.