London Branch RSCDS Workshop, Ceilidgh & Dance Registration Form

London Branch RSCDS Workshop Registration Form

Please fill out & print form and mail to:

RSCDS London Canada Branch,
P.O. Box 33012 , 1299 Oxford St. E.,
London , Ontario N5Y 5L4 .

Applications must be received by 15 February 2007 .

Preferred Salutation

Ms. Mr. Dr.

First Name*

Last Name *

Address1 *

Address2

City *

Prov./State *

Postal Code *

Country

Phone *

Ext.

Email *

Weekend Activity Options	$6 - Ceilidh $20 - Classes only $30 - Classes & Supper $30 - Supper & Evening Dance $50 - Full Weekend (includes Friday Ceilidh)
Total for all attending:	$
Dancing Level *	Less Experienced More Experienced
WAIVER: I/We understand that the RSCDS London Canada Branch is under no obligation to refund fees unless cancellation is received by Feb 15, 2007 . I/we understand that participation in Scottish Country Dancing demands a reasonable level of physical fitness, and that if I undertake any activity beyond my personal capability, I will not hold the London ( Canada ) Branch of the Royal Scottish Country Dance Society or its officers and members responsible for any resulting injuries.
Signature
(Printed)
Signature
(Printed)