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Registration Form


(return to Registration info)

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American Dance and Music Week — July 3-10, 2004

To register, please complete the following form and mail to:

BAY AREA COUNTRY DANCE SOCIETY
c/o Flip Alpern, Registrar
P.O. Box 501
Willits, CA 95490

Name(s)

 Phone (h)

Address

 Phone (w)

City

 State

E-mail

 Zip


Please check ONE:


Check all that apply:
Male
 Like to room with ____________________________
Female
 Like vegetarian meals/require special diet
Couple. I will attend only if
 Can offer a ride to camp
______________________________ attends.

 Please help find a ride
Do not print in the
camp roster:
 My phone

 I would like to apply for a work-trade scholarship

My email

 (Work scholarship applicants should send the deposit)

My address

Enclosed is:

________ $665 full tuition



________ $ 75 deposit



________ tax-deductible gift to BACDS

Please mail this form with check payable to BACDS

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