Online Registration form
(fill in the fields and press submit)

First Name:
Last Name:
E-mail:
    
Address:
    
City:
State:
Zip:
    
Phone:
Cell / Work:
       
       
Sharing Room With:
Level of Dancing:

Select Rate:

By April 1, 2010
($450.00 Per-Person – Double Occupancy)
($535.00 Per-Person – Single Occupancy)

After April 1, 2010
($485.00 Per-Person – Double Occupancy)
($570.00 Per-Person – Single Occupancy)

 
Special Dietary / Room Requirements:

Please remember Reservations are not final until PAYMENT IS RECEIVED:
$50.00 per-person nonrefundable deposit required with this form before April 1, 2010.
Full payment after April 1, 2010

By registering for this event I acknowledge that Check & Spin LLC, Nancy Brown, Gene LaPierre, their employees and affiliates cannot be held liable for loss or theft of articles or any injuries sustained by any persons attending the Exclusive  Dance Weekend.  Each person attending in any capacity whatsoever does so entirely at his or her own risk.  No refunds will be given for cancellations 1 week or less prior to the event.

Make checks payable to: Check & Spin LLC
Submit to: Nancy Brown
268 Bordentown Ave.
South Amboy, NJ. 08879

Info: Nancy - 732.525.0688 or Gene – 609.706.5287
e-mail: exclusivedanceweekend@verizon.net or rockstep@comcast.net