IndepenDance 2017
Welcome to IndepenDance 2017! We look forward to dancing with you!
Last Name *
Your answer
First Name *
Your answer
Name Tag Name *
Your answer
Street Address *
Your answer
City *
Your answer
State/Province *
Your answer
Zip Code/Postal Code *
Your answer
email address *
Your answer
Phone *
Your answer
I'm 25 or younger *
Dancers 25 and younger receive a $10 discount on the price of the weekend
I'd like the box lunch on Saturday *
The box lunch will be delivered on site shortly before noon. The lunch includes a sandwich, fruit, cookie and beverage for $10.
Your Weekend Price *
Please check all that apply
Required
Total for the Weekend *
Enter your total here. You can print this form for your reference. Checks can be made out to IndepenDance and sent to Pam Paulson, 235 S Greenfield Ave, Waukesha, WI 53186. You can use paypal by returning to the website and clicking on the paypal link. If it's after June 28th please bring your check with you.
Your answer
Waiver *
By checking below you agree that dancing can be hazardous and that you willingly assume full responsibility for your health and safety as you participate in the weekend. You agree to hold harmless the Prairie Waldorf School and its employees and agents as well as the Delafield Contra Dancers in the event of an accident. Photographs and video will be taken during the course of the weekend and could be posted on-line or used in promotional pieces. By checking below you agree that your image can be included.
Required
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