Ballroom Vermont Pre-Registration Form

BALLROOM VERMONT
A Division of Camps for Grownups, Ltd

PO Box 4179
Portsmouth, NH 03802
(800) 242-8785
Email: jazzvermont@comcast.net
www.ballroomdancecamp.com

Ballroom Vermont 2011 Registration Form

Instructions: Print blank form, fill out information and mail to address listed above.

Name:
Address:
City, State, Postal Code:
Home Phone:
Work Phone:
E-mail:
Partner:
Address:
City, State, Postal Code:
Home Phone:
Work Phone:
E-mail:

Please reserve our space for Ballroom Vermont 2011, July 17th-July 22nd at the Sunday River Resort in Newry, Maine.

I have enclosed a deposit totaling $750.00 for myself and my partner (or singles $400.00). My deposit is refundable upon written notice of cancellation prior to April 15, 2011. I understand that there are no refunds issued after April 15, 2011.

Signature:

For Office Use:

Deposit Pd Amt________ Date________

Check #_______________
or
Visa or Master Card #_______________

Expires ________ Code__________