Canadian Country & Swing Dance Classic Registration Form - 2003

Submission of this form by the party or parties listed above signifies the following: “We agree to hold the organizers of this event and their agents harmless from all suits, claims, or demands of every kind and character arising out of and in conjunction with this event. We hereby authorize the reproduction, sale, copyright, exhibition, broadcast, and/or distribution of any event videotape or photography without limitations. We understand the physical risks of entering dance competition and social dancing and assume full responsibility for any injury or personal damages resulting from the event named above. We certify that we are 18 years of age or older (applicable to Legal Guardian if under 18 years of age).”
Signature Date: Signature Date:

Follow– Please Print or Type
Name:
Address:
City: St/Prov:
Zip/Mail Code: Country:
Phone: ( )
Email:
UCWDC Contestant ID#

Line dancer/Lead– Please Print or Type
Name:
Address:
City: St/Prov:
Zip/Mail Code: Country:
Phone: ( )
Email:
UCWDC Contestant ID#

Complete this form, enclose payment and mail to the address listed below. Your registration packet will be available at the event.

Canadian Country & Swing Dance Classic Pass Descriptions
Until Feb. 15
After Feb. 15
Qty.
Sub-Total
Premium 3-Day Pass which includes: All Event Activities & “Free” Workshops & “Pay” Workshops
$85
Juniors $60
$95
Juniors $70
Basic 3-Day Pass which includes: All Event Activities & “Free” Workshops.
$55
Juniors $30
$65
Juniors $45
Friday event activities and ”free” workshops.
$25
Juniors $15
$35
Juniors $25
Saturday event activities and “free” workshops. *
$35
Juniors $25
$45
Juniors $35
Sunday event activities, “free” workshops and awards ceremony.
$30
Juniors $20
$40
Juniors $30
Video Pass “Must” be attached to your camera
$45.00 each
Workshop Tickets (available with day or weekend pass purchase only)
$5.00
each
Spectator pass includes daytime ballroom access only.
Evening Dances Dance in our ballroom Friday night or Saturday night.
Purchase at registration
UCWDC Competition
See Attached Competitor Form
Just Dance Competition
See Attached Competitor Form
Master Card / Visa accepted but this is a US credit account and will be charged in US$
$5.00 Handling Fee
Total
Purchase at registration

Americans Make Check or Money Order payable to:
Excalibur Dance Productions
Canadians Make Check or Money Order payable to:
Steven Howorka
**$25.00 returned check fee**

Sorry...absolutely no refunds.
Credit for next year’s event only.

Adult Junior 13-17 Youth <13

Adult Junior 13-17 Youth <13

Credit Card Information
Master Card Visa
Name Printed On Card
Card #
Expiration Date /
Signature
Date / /

Send registration and payment to:
Excalibur Dance Productions
1084 Todd Farm Dr. Suite 102
Elgin, IL 60123 USA