Harvest Moon Dance Weekend 2019 Registration Form
Please fill out a SEPARATE REGISTRATION FORM for EACH person attending. If you will be paying for more than one registrant, be sure to note that below. Please include the combined amount in your "total to pay," as well as noting each person's "personal events total."
Last name *
Your answer
First name *
Your answer
Email address *
Your answer
Street address *
Your answer
City *
Your answer
State *
Please use the 2-letter postal abbreviation.
Your answer
ZIP code *
Your answer
Phone *
Please give your preferred phone number (xxx xxx-xxxx)
Your answer
The above number is a ___________ phone. *
Alternate phone
(xxx xxx-xxxx)
Your answer
The above alternate number is a __________ phone.
Please note the form of your name you prefer on your name button (first and last).
Your answer
Full-time students automatically qualify for the reduced registration price. Non-students who have limited income and wish to request this price should contact us at chicagolandecd@gmail.com.
Events *
Mark the events you will attend below. If you are coming and paying for the full weekend, mark ONLY that; otherwise, mark all the events you are now registering to attend. Please note the price of each event and keep a tally, so you can give the events total in a later question.
Personal events total *
Enter the total amount owed for dance events that you will attend. If you have kept a tally, please put in all the figures: e.g. if you are paying for Saturday afternoon, Saturday evening, and Sunday afternoon, please note: $25+$35+$30=$90
Your answer
Payment *
If you are paying only for yourself, answer this question, then skip to "Donation amount" and "Total to pay" below.
If someone else is paying for you, enter that person’s name below.
Your answer
Paying for
If you are also paying for additional persons, enter their names. Please ensure that a separate registration form has been completed for EACH ATTENDEE.
Your answer
Donation amount
If you would like to donate an additional amount toward the costs of this year’s Harvest Moon Dance Weekend, please enter your donation amount here. We thank you very much for your support!
Your answer
PayPal fee owed
If you are paying with PayPal, please include $5 PER ATTENDEE to cover the cost of using this service.
Your answer
Total to pay *
This will be the total for the dance events for yourself and anyone else for whom you are paying, plus any optional donation, plus any PayPal fee(s). PLEASE NOTE that fees paid for others should be entered ALSO on that person's registration form under their "personal events total," and the PayPal surcharge is $5 PER ATTENDEE. If you are not paying for yourself (or filling out form out for someone else for whom you are paying), this number should be 0. A single check may be sent for multiple registrations. The number here should match the amount on your check or what you pay via PayPal.
Your answer
Skill level *
Please specify your English country dancing skill level. We expect all registrants to have at least some experience with ECD and to be familiar with basic ECD figures, e.g., heys, poussettes, and figure 8s. Events will be designed for a mixed-level group.
Transport needed
If you will need help with local transportation, please let us know here. We can’t promise, but we will try to arrange for rides!
Your answer
Transport info
If you are arriving by plane and would like to connect with others who might share airport transport, please provide your airport, flight information, and arrival time (or send this information to us later by email to ChicagolandECD@gmail.com, please).
Your answer
Transport offer
Will you be able to offer rides in your car during the weekend?
If you will be staying in the area, please let us know where. If you don't have housing arranged yet, please consult the website for hotel options. We apologize, but home hospitality is extremely limited. If you are truly in need of it, please contact us as soon as possible.
Your answer
Allergies and fragrance policy
Do you have any allergies (food, fragrance, other) or physical concerns that we should be aware of? This is a fragrance-free event, so the use of scented products is prohibited.
Your answer
Scholarship application
A limited number of work scholarships are available. These offer $40 towards the cost of full weekend registration, in exchange for help with tasks during the weekend. The deadline for applying is September 14. Please supply a brief description of your needs here and select and deduct the work scholarship amount from the total owed, as indicated above.
Your answer
How did you hear about our weekend? *
Mark all that apply, please.
If "other" above, please specify
Your answer
Questions for us?
Do you have any questions you'd like us to answer? Please note here, or email us at ChicagolandECD@gmail.com.
Your answer
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