Winnipeg Branch Registration Form

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(July 1, 2023 to June 30, 2024)

After you complete this form payment may be provided to the registrar by:

- Mail to Doug Durnin 11 Pembridge Bay Winnipeg MB R2M 4H1 (phone: 204-253-4213)

- Payment at the Open House evening (Monday, September 11th) or your first class

- etransfer to: info@rscdswinnipeg.ca

Contact Information

Registrant Last Name: *

Registrant First Name: *

Registrant Address: *

Registrant City / Province / Postal Code: *

Registrant Phone: *

Registrant E-mail *

Type of Membership

Choose one of the options below. Note For Half Term Registration: No post-dated cheques for 2nd term. The 2nd term payment $60.00 for half term registration is due first class in January.

Choose one membership option: *

Dancer Full term - September to April ($115 class fee; $70 membership fee) $185.00

Dancer Half term - Sept to Dec or Jan to Apr ($60 class fee; $70 membership fee) $130.00

Membership only $70.00

Required

Classes

Both class nights are for all levels of dancers. Intake for new dancers is Mondays 7:30 - 9:30

Home Class choice *

Additional Class you plan to attend: *

Total Payable to RSCDS Winnipeg Branch

No refunds without the approval of the Committee of Management

Receipts provided for cash only

Choose total amount *

Choose payment choice

- bring payment to Open House evening or your first class

- mail cheque to Doug Durnin 11 Pembridge Bay Winnipeg MB R2M 4H1

Emergency Contact Information

Emergency Contact Name: *

Emergency Contact Phone: *

RSCDS has permission to include my name and the following information on the membership list distributed annual to members *

Phone

Address

None of the above

Required

Permission is granted to the Winnipeg Branch to record and use my likeness, image and performance on film, tape, still images or otherwise. *

I understand that participation in Scottish Country Dancing requires a reasonable level of physical fitness and if I undertake any activity beyond my personal capability, I will not hold the Winnipeg Branch or the RSCDS responsible for any resulting injuries. *

I have read the above statement and agree

Required

Submit

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