Print this page and complete it, or write a letter including the required information, and mail it to Banjo Burke Memorial Fund PO Box 937  Greenwood, NY 14839  (607) 225-9928 CLEARINGHOUSE APPLICATION   Name      _________________________________________ Address   _________________________________________                 _________________________________________                 _________________________________________ Phone_________________e-mail________________________ I play the___________________________________________ I have been playing Irish music for _____________ years. I need a new instrument because__________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________________ My future plans/hopes with regard to music are_______________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ I understand that, by accepting an instrument from Banjo Burke Memorial Fund, I am agreeing that, if the time comes when I no longer play the instrument, I will not sell it, but will donate it back to Banjo Burke Memorial Fund or to another Irish musician in need. Signature___________________________________Date____________