Online Registration Form

Registrations will be accepted on a first come/first served basis. SPACE IS LIMITED!
NOTE: Only VISA, MasterCard and Discover registration payments are accepted via this form.

If you are paying with a CHECK: Do not use this form. Please use the downloadable form [PDF].
If you do not wish to use this on-line registration form, or if you are having trouble with it,
please use the downloadable form [PDF]. Fill out the form and mail it to the address below.

Or call (707) 826-3731 to register (Open Mon.-Fri., 8 a.m.-5 p.m. PST) VISA-MC-Discover

Mail the PDF registration form with your check or credit card information to:

Afro-Cuban Music and Dance
College of eLearning & Extended Education
Humboldt State University
1 Harpst Street
Arcata, CA 95521-8299


STUDENT INFORMATION

* - Required Field

  


Enter your date of birth:*

Your date of birth is requested so that Humboldt State University may identify records that are unique to you.

*
Select your gender: * Male    Female
Have you previously attended Humboldt State University? * YES     NO
Have you completed a Bachelor's Degree or higher? *

List all previous names you have used.

(Examples: Birth Name, Maiden, Previous Marriage, Legal Name Change)

MAJOR AREAS OF INTEREST & SKILL LEVELS

INTEREST AREAS: Check all that apply.


MUSIC SKILL LEVEL (Self-determined - choose one): 

NOTE: Musicians must be proficient sight-readers and able to keep up with other players of an intermediate to advanced level in Hilario Duran's Afro-Cuban Traditional Music Ensemble.

DANCE SKILL LEVEL (Self-determined - choose one):

 

WORKSHOP REGISTRATION OPTIONS
Please check the box next to your choice.

       $650 (31077)

Registrations received after July 1: $675


Full week fee includes admission to all available music and dance classes offered each day, and the evening events. Partial scholarships may be available for full week participants. See the website for more information about applying for a scholarship.

    

          $130 per ticket
 

A Plan Five ticket allows you to attend FIVE workshops and/or lectures of your choice. You may purchase up to four Plan Five tickets. Select one option above.

REGISTER FOR DAILY           $130/day

Check day(s) attending:

       
 

 

OPTIONAL: Drum rental priority is given to full-week participants.


SOUVENIR SHIRT OPTIONS

If you are interested in purchasing a souvenir shirt should they become available, indicate the quantity desired of each style and size here. Shirts may be available for purchase during the program.

  T-SHIRTS:                    
  LONG-SLEEVED SHIRTS:                    
  TANK-TOPS:                    
ACADEMIC CREDIT (Optional)
Participants who attend all workshop classes, all days, may earn up up to 3 UNITS at $50 additional fee per unit.

Enter number of units next to the course credit option.
(Enter up to 3 units in any combination):





DANC 480

 
To receive academic credit, you must provide the FOLLOWING:
All sensitive information is submitted via SECURE SERVER, and is requested pursuant to Section 41201, Title 5, Calif. Code of Regulation and Section 6109 of the Internal Revenue Code.   More information (opens new window)
RACE/ETHNICITY INFORMATION
Your voluntary response is requested to comply with Federal and State legislation.

If the California State University system is asked to report only ONE summary race/ethnicity description for you, choose the ONE category below that you want us to report:

Choose one

Two or more races/ethnicities

Decline to state

CAMPUS HOUSING OPTIONS

Optional on-campus housing in the College Creek residence hall is available for an additional fee for the entire week, single occupancy (when available) or double occupancy. You may request a specific person as a roommate.

Rates for the entire week include three meals per day (except brunch and dinner only on Sunday).
Details about the campus housing facilities are available at the Conferences Services website.

TOTAL REGISTRATION COST
$

If you cannot read the characters shown, click on the Refresh icon  refresh symbol below until you see an image that you can read.

Alternately, you can click the Speaker icon symbol to hear an audio of the characters. Type what you hear in the box.

If you are still having difficulties, please call 707-826-3731 to register over the phone. (Monday-Friday, 8 a.m.-5 p.m.)



Please review the above information for accuracy before submitting this registration form.



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