CHEHALIS 2010 DANCE CAMP APPLICATION

NAME __________________________________________________

Address ____________________________________________________________________________________

Email ____________________________________________________

Phone (H) _____________________ (W) _____________________

NAME __________________________________________________

Address ____________________________________________________________________________________

Email ____________________________________________________

Phone (H) _____________________ (W) _____________________

#Females:____   #Males:____   #Couples:_____

#Omnivores:_____   #Vegetarians:_____   #Vegans:______

Include my name/address on participants list (Y/N): ____

I need a ride from _________________________________

I can give a ride from ______________________________

I can drive or billet talent (specify - Thanks!!) _______________________________________________

$Cdn/US at par
Adults before Aug 27 ____@ $215 =_________
after Aug 27 ____@ $235 =_________
Children age 5-12 ____@ $105 =_________
age 0-4 ____@ free
Ferry tickets car + driver ____@ $44 =_________
adult passenger ____@ $11 =_________
Private room (phone for availability first!)
***per person cost*** ____@ $30 =_________
CDSS members discount ____@ $5 -_________
Scholarship request (max $100) -_________
donation (any amount) +_________
TOTAL ENCLOSED =_________

Mail application with cheque payable to:
Vancouver Country Dance
2984 Turner St., Vancouver BC, V5K 2G7