CapitalDance.com Website ---- Registration Form --file Regform01.htm

Registration Form 2001

Complete the form below (one for each adult) and print it. You may FAX it or send it online by pressing the button "submit" at the bottom of the page. Please mail $30 for each person (check or money order paid to S. Batzri).

Use the mouse or the TAB (forward) and shift-TAB (backward) key to navigate from field to field

Name	First Last
Gender	Male Female
Street
City
State
Zipcode
Country
Telephone	Home Work/Daytime
Fax Number
E-mail
Birthday	Day
Accommodation Desired	Double Occupancy Single Occupancy
Sharing room with (if any)	( if blank, we will assign your room-mate)
Private Bathroom	YES NO ( If blank, room with shared bath will be assigned.)
Age Group	Below 30 30's & 40's 50 & plus
About Children	Number of children attending: Are meals required? Y N Are beds required? Y N Will child attend dance workshop? Y N Enter children's names and ages?
Travel: Share a Ride	I can offer a ride to people I would like a ride if one is available from
Dance Level	I am a Beginner Intermediate Advanced
Special Meals	Kosher Only (add $35) Kosher Vegetarian (add $25) Vegetarian (If blank, kosher style will be served)
Special Workshops	I am interested in Beginners Workshop Y N I am interested in Children (10-18) Workshop Y N Note: These workshops will require sufficient attendance
Musical Instrument	I Will bring
More Information	Anything else we should know?

Until you take this action, your Registration has not
been transmitted and you can still make changes.

Before you transmit your Registration you may clear the
entire form and start over at any time.

Please print this form and then transmit it. Make check payable to:
[deleted... currently this form not valid].

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