Countryedge.com
Summer
[pic]
July 30th, 2011
July 29th: Friday Night ALL request dance party from 7 p.m. to 11pm
Saturday Workshops Begin At 9am until 5:30pm – Open Dance From 7pm until 11pm
Featured Instructors:
Simon Ward * Scott Blevins * John Robinson * Carole Daugherty
Jill Babinec * Bob & Denise Boyle * Sharman Toomey
Your Event Host: Mark Cosenza
|[pic] |Place: |
| | |
| |Crowne Plaza Hotel |
| |5440 N. River Rd. - Rosemont, Illinois 60018 |
| |Tel: 1-847-671-6350 |
| |Overnight Room Block Available For Fri and Sat Night…. |
| | |
| |Free Round Trip Shuttle from O’Hare Airport |
Summer Line Dance Mania
Registration Form ~ Please use one form per address!
|Dancer #1 Name (Please Print) |Address |
|Dancer #2 Name |City/State/Province |
|Daytime Phone ( ) |E-mail Address #1 |
|Evening Phone ( ) |E-mail Address #2 |
|Item & Description |Before July 1 |After July 1 |QTY |TOTAL |
|Event Pass: Admission to ALL workshops, Evening Open Dancing (both Friday & Saturday) and |$60 ea |$70 ea | | $ |
|free video pass! | | | | |
|Friday / Saturday Night Dance Only (If only attending one night, circle the night of |$10 each night |$10 each night | | $ |
|choice) | | | | |
|Saturday Workshops / Night Open Dance Only |$50 ea |$60 ea | | $ |
I, the undersigned, for myself, my heirs, executors and administrators, hereby waive and fully release and agree to hold harmless the "SUMMER LINE DANCE MANIA" workshop weekend, its organizers, employees, and their agents harmless from any and all lawsuits, claims or demands of any and every kind and character arising from and in connection with this Event, whether as a spectator, staff member, or attendee. I understand the physical risks of social dancing and assume full responsibility for any injury or personal damages resulting from the " SUMMER LINE DANCE MANIA " workshop weekend. I hereby authorize the reproduction, sale, copyright, exhibition, broadcast and / or distribution of any event videotape and photographs of me during all the accompanying activities on JULY 29 – 30, 2011 without limitations. I certify that I am 18 years of older (application to Legal Guardian if under 18 years of age.) I understand and acknowledge that NO REFUNDS will be issued under any circumstances.
Dancer #1 Signature: _______________________________________________ Date: _________________________
Dancer #2 Signature: _______________________________________________ Date: _________________________
| Method of Payment - NO REFUNDS |Form must be filled out and signed by person named. |
|[ ] Check or [ ] Money Order made payable to MARK COSENZA [ ] Online Payment Via Paypal |Mail registration with payment to: Mark Cosenza |
|Note: Cancelled check / money order receipt is your receipt. There will be a $20 charge for returned checks.| |
|Credit Card purchases may be charged online by going through link at Website |5512 N. Normandy Avenue Chicago, IL 60656 |
|Online Credit Card/Paypal payees must complete the online registration form at . | |
| |Questions / Information, |
| |Email Mark through his website at |
| | |
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