Atlanta All-Star Swing Fling
Registration Form

If you are mailing your Registration Fees, it must be postmarked by June 7th, 2010
How is my information used?

Problems with Registration or need to make changes? Please email the webmaster
Submission of this form by the party or parties listed below signifies the following statements: "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. I/We hereby authorize the reproduction, sales, copyright,exhibition,broadcast, and/or distribution of any event video tape without limitation. I/We understand the physical risks of entering dance competition and/or social dancing and assume full responsibility for any injury or personal damages resulting from the named event above. I/We certify that we are 18 years or older"

Primary Registree

 

    
First Name:
    
     		Last Name:
  
 Address (Used for Bill Robinson Event Mailings
and Video Orders):
  
City:

State:
Zip:
 
Phone: 
  
E-mail: 
  		 
  

 Secondary Registree 
    (Additional person allowed to pick up order)		  
First Name: 
 		 Last Name:
Street Address (used for Bill Robinson event mailings)
  
City:
 State:
 Zip:
  
Phone: 
  
E-mail: 


  

Weekend Pass................................................ x $90 ($80 before June 7th)
(includes all workshops and both night's dances)

Saturday Pass.................................................. x $60 ($50 before June 7th)
(includes all workshops on Saturday and Saturday night dance)

Friday Dance................................................... x $10
(Friday Night only)

Saturday Dance............................................... x $15
(Saturday Night only)

Video Pass...................................................... x $20
(Bring your own camera)

Video Notebook (DVD).................................x $35