"Windy
City Line Dance Mania"
October 10,
11, 12 2003 Registration Form
(Please
Use One Form Per Person)
Name (Please
Print)______________________________________
Address_____________________________________________________________________________
City/State/(Province)_________________________________________
ZIP ___________
E-mail:_______________________
Daytime Phone_________________Evening
Phone_________________
|
Item &
Description |
Before
Sept 1st |
Before
Oct 11 |
QTY |
SUB
TOTAL |
|
WEEKEND PACKAGES
VIP Pass
Admission to ALL workshops, Evening Open Dancing, Dinner &
Entertainment Show and free video pass! |
$90.00 ea |
$100.00 ea |
____
|
$ ______
|
|
Group VIP Pass (Groups of 8 or More): -
*Best Value!
Admission to ALL workshops, Evening Open Dancing, Dinner &
Entertainment Show and free video pass! (Must send all registrations
together in one envelope.) |
$85.00 ea |
$95.00 ea |
____
|
$ ______
|
|
Junior 3-Day Weekend VIP Pass (Age 7-15)
Admission to ALL workshops, Dinner & Entertainment Show and free
video pass! |
$50.00 ea |
$60.00 ea |
____
|
$ ______
|
|
Youth Pass (Age 6 & Under) |
- FREE - |
- FREE - |
____ |
- FREE - |
|
3-Day Weekend Pass
Admission to ALL workshops, Evening Open Dancing |
$70.00 ea |
$80.00 ea |
____
|
$ ______
|
|
Group 3-Day Weekend Pass (Groups of 8 or
More):
Admission to ALL workshops, Evening Open Dancing |
$65.00 ea |
$75.00 ea |
____ |
$ ______ |
|
Item &
Description |
Before
Sept 1st |
Before
Oct 11 |
QTY |
SUB
TOTAL |
|
DAILY PACKAGES
FRIDAY Workshops & Open Dance
Included workshops, evening dance, does NOT include t-shirt NOR
dance description book |
$40.00 ea |
$45.00 ea |
____
|
$ ______
|
|
Saturday Workshops & Open Dance
Includes workshops, evening dance, does NOT include evening dinner
or show, T-shirt NOR dance description |
$60.00 ea |
$70.00 ea |
____
|
$ ______
|
|
Saturday Evening Dinner & Show - N/A
after 10/7
Includes all you can eat buffet, beverage, 27% tax & gratuity,
admission to Saturday evening dinner & show. NO admittance to
anyone without a Saturday evening dinner ticket or Saturday evening
show ticket |
$25.00 ea |
$30.00 ea |
____
|
$ ______
|
|
Saturday Show & Dance
Show only DOES NOT INCLUDE FOOD. NO admission to show without a
Saturday evening show ticket |
$20.00 ea |
$25.00 ea |
____
|
$ ______
|
|
Sunday Workshops
Does NOT include T-shirt NOR dance description book |
$30.00 ea |
$30.00 ea |
____ |
$ ______ |
|
FRIDAY or SATURDAY Open Dance ONLY
(circle) |
$10.00 ea |
$10.00 ea |
____ |
$ ______ |
|
ADD - ON'S
Weekend VIDEO PASS (Per Video Camera) |
$20.00 ea |
$20.00 ea |
____
|
$ ______
|
|
Event T-Shirt
Note: We highly recommend you order shirt(s)
before October 1st, 2003.
Size: S ____, M ____, L ___, XL ___, XXL ____, XXXL ____ |
$10.00 ea |
$15.00 ea |
____ |
$ ______ |
|
Step Description Booklet
|
$10.00 ea |
$15.00 ea |
____ |
$ ______ |
|
CHOREOGRAPHY
COMPETITION |
Before
Sept 1st |
Before
Oct 11 |
QTY |
SUB
TOTAL |
|
NOTE: Requires the purchase of a weekend pass.
Please read rules located at
http://faastcountry.com prior to competition! This is a demo
and teach competition and you will be assigned a 30 minute
timeslot - all step sheets must be submitted prior to 10/1/03.
All 12 Slots have been filled for 2003. |
N/A |
N/A |
|
|
|
Credit Card Processing Fee |
$5.00 |
$5.00 |
|
$ ______ |
|
There are NO other Ticket Order Options
available other than those listed above. NO REFUNDS AFTER
9/1/03 |
GRAND |
TOTAL |
|
$ ______ |
|
|
|
This information was made available through:
(IMPORTANT! PLEASE CHOOSE ONE OF THE SELECTIONS BELOW!) |
|
[ ] Max Perry |
[ ] Scott Blevins |
[ ] Kathy Hunyadi |
[ ] John Robinson |
|
[ ] Peter Metelnick |
[ ] Judy McDonald |
[ ] Michele Perron |
[ ] Doug & Jackie Miranda |
|
[ ] Larry & Tracy Harmon |
[ ] Denise Stone |
[ ] June "The Lady In Black" |
[ ] Jo Kinser |
|
[ ] Heather Frye |
[ ] Debi Bodven |
[ ] Larry Bass |
[ ] Louie St. George |
|
[ ] Brian Barakauskas |
[ ] Joanne Brady
|
[ ] Karen Hedges |
[ ] Country Edge Web Site |
|
|
[ ] Other _______________________ |
|
|
I, the undersigned, for myself, my heirs, executors
and administrators, hereby waive and fully release and agree to hold
harmless the "WINDY CITY LINE DANCE MANIA" workshop weekend, it's
organizers, employees, and their agents harmless from any and all
lawsuits, claims or demands of any and every kind and character
arising from and in connection with this Event, whether as a
spectator, staff member, or attendee. I understand the physical
risks of social dancing and assume full responsibility for any
injury or personal damages resulting from the " WINDY CITY LINE
DANCE MANIA " workshop weekend. I hereby authorize the
reproduction, sale, copyright, exhibition, broadcast and / or
distribution of any event videotape and photographs of me during all
the accompanying activities on October 10, 11 & 12, 2003, without
limitations. I certify that I am 18 years of older (application to
Legal Guardian if under 18 years of age.) I understand and
acknowledge that NO REFUNDS will be issued after 9/01/03 under any
circumstances.
Signature:
_____________________________________
|
|
Method
of Payment
NO REFUNDS AFTER 9/1/03
Check [ ] Money Order [ ]
Paid Online [ ]
o payable
to Dean & Mary Faast
o Cancelled check / money order receipt is your receipt
o There will be a $20.00 charge for returned checks.
Credit Card: [ ] VISA [ ] MASTERCARD
Card Holder Name: (As Printed on Front of Credit Card)
___________________________________________
Card #___________________________________
Expiration: ____/____/____
Credit Card payments can fax
the registration form to Mark Cosenza at 1-253-276-6763 |
Mail registration with payment to:
Mark Cosenza
7529 W. Isham Avenue
Chicago, IL 60631
Questions /
Information Call:
Mark Cosenza at
773-774-7024
email by clicking
here.
Form must be filled
out and signed by person named on form. Online payments
can fax the registration form to Mark Cosenza at
253-276-6763 |
There are NO other Ticket Order Options
available other than those listed above.
Questions / Information Call:
Dean/Mary Faast at 651-738-0712 e-mail:
faastcntry@aol.com
Mary or Dean Faast
2888 Castleford Court
St. Paul, MN 55125
|
If your printer is cutting off key
areas of this form, click
here for a more condensed 1 page standard registration form! (You
must have adobe acrobat installed to view). For a Microsoft Word
copy, click here
Click
here
to return to the flyer
|
