Name:  ___________________________________________________________________________________________

Address: __________________________________________________________________________________________

Home Phone:  ____________________________

Cell Phone:  ____________________________________  
  Gender:   __Male  ___ Female

Email address: ______________________________________________________________________________________

Provide names of all adults and children attending: ___________________________________________________________

Overnight Accommodations

   ____ I plan to Camp        ____Tent    ____ Camper  

   ____ I plan to stay in local hotel and driving daily to dance camp

   ____ I will be staying with someone locally

Registration Deadline is June 10.
Includes 3 meals on Saturday and Sunday Breakfast  

Adults:  
$60.00 and sign up to volunteer for two 30 min. jobs
$75.00 if you don't want to volunteer

Children over 13:  
$20.00 and sign up to volunteer for two 30 min. jobs
 $25.00 if you don't want to volunteer

    Registration after June 10    

   ____ Number of Adults attending @ $__________  per person = $________________

   ____ Number of Children attending @ $_________ per person = $________________
 

"Evening & Day Dancers only" MUST pre-registered...limited spaces.

   
Total paid by Check ---   Check #__________   Check Amt. __________

OTHER

   ____ I am a caller and would like to call a few dances      ____ Square Dances     ____ Contra

Make checks payable to: Marianne O'Doherty

Mail registration and payment to:
Marianne O'Doherty
June Moon Dance Weekend
515 Wilson Ave
Morgantown, WV 26501

If you have questions please call me at
1.304.291.1840 (home)
1.304.685.9455 (cell).
OR
email us at   junemoondance@yahoo.com