Registration Form
2011 Fort New Salem Foundation Dulcimer Festival
August 12-14, 2011

Name _______________________________________________________________

Address _____________________________________________________________

City ____________________________________ State _______ Zip _____________

E-mail address ________________________________________________________

Phone _______________________________________________________________

Names of Additional Attendees: ___________________________________________

Cost for Festival Pass
____ All weekend ($40* or 45 per person)
____Saturday Only $25* or 30 per person)
____Sunday Only ($20 per person)

Total Enclosed ___________

*$5 discount if received by August 1, 2011
**Make checks payable to Fort New Salem Foundation, Inc.

Send Registration by regular mail to:
Linda Sigismondi
474 Kathy St.
Gallipolis, OH 45631
740 446-9244
lsigismondi@att.net