CapitalDance.com Website ---- Registration Form

Registration Form 1999

Complete the form below (one for each adult) and print it. You may register by FAX or 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	Traditional Suite Royal Suite
Occupancy	Single Sharing
Sharing room with (if any)	( if blank, we will assign your room-mate)
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
Meal Preference	Kosher Only (add $35) Kosher Vegetarian (add $25) Vegetarian Kosher Style
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, make check payable to:
[DELETED... currently this form is not valid]

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