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Skye Humphries & Naomi Uyama Workshop Registration Form

Name
eg: Alex Smith
Use separate submission for each person.
Email Address
eg: asmith@aol.com
If you do not have email be sure to provide a telephone number below.
Telephone
eg: 508–555–1234x56
eg: 508–555–1234
eg: 508–555–1234
Friday Newton Workshops
December 2, 2011
 (7:30–8:30pm)
(8:45–9:45pm)
Saturday Newton Workshops
December 3, 2011
 (12:15–1:15pm)
(1:25–2:25pm)
(2:35–3:35pm)
(8:15pm–12:30am)
Sunday Newton Workshops
December 4, 2011
 (1:30–2:30pm)
(2:45–3:45pm)
(4:00–5:00pm)
(5:15–6:15pm)
Cost per person
Discounts are for the same person taking multiple workshops.
 Number of Workshops Early Bird
Payment by
November 2, 2011		 Discount
Payment by
November 23, 2011		 Full
Payment after
November 23, 2011
Any single workshop $15 $19 $23
Any 2 workshops $30 $38 $46
Any 3 workshop $45 $57 $69
Any 4 workshop $55 $70 $85
Any 5 workshop $65 $83 $101
Any 6 workshop $75 $96 $117
Any 7 workshop $85 $109 $133
Any 8 workshop $95 $122 $149
All 9 workshops $105 $135 $165
All 9 workshops & Uptown Swing Dance $115 $145 $175
Uptown Swing Dance +$15
(+$10 with student ID)
Total Amount
Role
Where you heard of us
Status
If you are not already on our mailing list complete the following fields.
If your address is already on our mailing list skip the following fields.
If your address has changed complete the following fields.
If same address as another person already registered, just note their name in the Comments section below and skip the following fields.
Extra line for address, leave blank if not needed.
Street
Town
State
eg MA
ZIP
Comments
Verification Code
9421
Used to help prevent SPAM-Bot submissions.
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