EmailMe Form - Cash/Check April 2013 Dance Camp Registration

Name *

First Last

Referred By

First Last

Studio or Collegiate Team Name

If you are attending the workshop as part of a Studio or collegiate team, please enter Studio/Team Name here

Email *

Phone *

### - ### - ####

USA Dance Member #

Special Food Request(i.e. vegetarian, food allergies):

How would you rate your level of dance experience? *

Beginner

Intermediate

Advanced

What style(s) of dance do you have experience in?

What type of dance activities have you participated in? (Select all that apply):

Payment Option *

Cash

Check

Debit/Credit Card

Select Package Option *

$150 Dance Camp and Showcase

$130 Dance Camp Only

$109 Junior/Collegiate Dance Camp and Showcase

$99 Junior/Collegiate Dance Camp only

Do you have a promo code? Select option here:

If using a Promo and paying by Cash/Check please take 10% off listed price. Please make checks payable to Ryan Lewis. Promo discounts not applicable to already discounted Junior/Collegiate Rates.