R E G I S T R A T I O N   F O R M
2007 Harvest Moon Swing Out!


   Name #1

:   Lead Follow
   Address :  
:  
   City, State, Zip :  
   Phone :       Fax:
   E-Mail :  


   Name #2

:   Lead Follow
   Address :  
:  
   City, State, Zip :  
   Phone :       Fax:
   E-Mail :  


   

Weekend Package (Saturday and Sunday)
Package includes ALL classes and both dances!
Package does NOT included the Sunday night dinner
$150 - if received AFTER October 29, 2007

____at $135= $______   
    Sunday Night Dinner
____at $20= $______   


   Notes:
   If you are purchasing a series card in our November Lindy Hop classes, you get a discount on the Harvest Moon Package of $10.

   All single classes are $20.00 per person at the door.

   Pick up registration materials at the first class you attend.

TOTAL ENCLOSED   = $_____   
All refunds are subject to a $25 handling fee. No refunds will be given after October 31, 2007.


   PAYMENT METHOD
        Money Order   Check (payable to PBDA)
        Visa  Master Card
            Expiration Date:


        ___________________________________________________________________________
        Cardholder’s signature                        Date



IMPORTANT! PLEASE READ AND SIGN!
I acknowledge that Pasadena Ballroom Dance Association has informed me that there can be risks of injury associated with all forms of Swing dancing. I assume all such risks and agree that PBDA will not be responsible in any way for any injury I may suffer in or as a result of the classes and/or dances at Harvest Moon Swing Out.


_____________________________________________________________
Print Name #1                           Signature and Date


_____________________________________________________________
Print Name #2                           Signature and Date

Please PRINT, COMPLETE and SIGN
Mail or fax this form to us!

QUESTIONS?
Call (626) 799-5689