Registration form for Raincoast Ruckus 2010

(You can print out the blank form and fill it in by hand, but the results will usually be more legible if you fill it in while it's in your browser and then print out the filled-in form. Note that you can't actually register online, sorry.)

Name(s):

Street & No.

Town/City: Postal Code / Zip:

Tel.: (H) (W)

E-mail:

I am willing to have my name on the participant list: Yes  No

Note that Early Bird rates apply if your application
is postmarked before February 5.

WEEKEND PACKAGE
_ _ _ Before Feb 5 # @$110 Cdn/US = $
Weekend Early Bird Draw: win $55 refund!
_ _ _ On/after Feb 5 # @$130 Cdn/US = $
Only Friday dance: # @$16 Cdn/US = $
Saturday only:
All day + evening dance
_ _ _ Before Feb 5 # @$65 Cdn/US = $
_ _ _ On/after Feb 5 # @$75 Cdn/US = $
Individual workshop # @$16 Cdn/US = $
Evening dance # @$18 Cdn/US = $
Sunday only:
All day + afternoon dance
_ _ _ Before Feb 5 # @$35 Cdn/US = $
_ _ _ On/after Feb 5 # @$40 Cdn/US = $
Individual workshop # @$16 Cdn/US = $
Afternoon dance # @$12 Cdn/US = $
Registration Subtotal = $
Scholarship (optional)
Plus donation + $
OR Less request - $
TOTAL PAYABLE: $

Make cheque or money order payable to
“Raincoast Ruckus” and mail to:

Raincoast Ruckus c/o Joanne Williamson
5644 Ewart Street
Burnaby, B.C.
V5J 2W7

Carpool: I need a ride for # people
I have room in my car # people

Billet / Homestay: Will be assigned by February 26.

Host: I have space for # people X #beds
Beds are: #double #single #sofa #floor
I have pets. (type)

Guest: I need room for # people X #beds.
Want beds: #double #single #sofa #floor
I/we have allergies to:

Back for 2010!

Saturday potluck dinner
Relax with new and old friends.
Let us know if you might join in.

Yes, I am willing to volunteer:

Tasks I could do:

  • Put up / take down decorations
  • Move equipment after Saturday dance
  • Monitor and clean up Community Room
  • Hospitality tasks (e.g., make coffee)
  • Any small task