Spring Fling Application Form

Title

First Name

Last Name

Age

Date of Birth

Address1

Address2

Town/City

County

Postcode

Country

Telephone Number

Email Address

Emergency Contact Name

Telephone Number

Do you have any medical conditions / allergies / dietary requirements?
Please state the nature of your condition / allergy / requirement.

RSCDS Member

YesNo

Choose which type of ticket you would like to buy

Resident members before 31^st January 2012

£110.00

Resident members after 31^st January

£120.00

Resident non-members before 31^st January

£120.00

Resident non-members after 31^st January

£130.00

Non-resident members

£60.00

Non-resident non-members

£70.00

Friday night dance only: Members

£6.00

Friday night dance only: Non-members

£8.00

Saturday night dance only: Members

£7.00

Saturday night dance only: Non-members

£9.00

Please answer the following questions so that you are placed in the most appropriate SCD Classes

Is this the first time you have attended?

YesNo

Please choose from the following classes

Morning Classes

Afternoon Classes: (Please select first and second preference)

First Preference:
*Very limited numbers are available for this workshop, apply early to avoid disappointment

Second Preference:
*Very limited numbers are available for this workshop, apply early to avoid disappointment.

Agreement • I have read and understood the information provided in the booking form.
• I understand that the Royal Scottish Country Dance Society is under no liability whatsoever in respect of any personal loss or injury which I may sustain.
• I understand that if I am accepted as a student and withdraw after 31st January 2012, only a partial refund will be made less an administration fee of £25.00.

Total

I agree

or Reset