Winter WarmUp 2011 Registration Form

Please fill in the name of each person, indicating the appropriate age group. The form will automatically determine the cost for the weekend with a total below. When you have completed the form,
View Price List

This form presumes that all members of your party will be attending on the same days. If this is not the case, please print the form multiple times, once for each schedule.

Register by Nov 19, 2011 to receive the early registration discount!

A limited number of working scholarships are available. Contact Jan Pettibone at 614-216-0762 by 11/19/2011.

By default, your badge will display FirstName + LastName + City + State. If you want something else, let us know!

Mail your completed form and check (payable to "Big Scioty Barn Dance") to:

c/o Dave Notman
5278 Timberline Rd.
Columbus, OH 43220-7306

Winter WarmUp 2011 Registration Form

 This is a late registration (after 11/19/2011).
 Entire Weekend    
 Friday Dance    Sat. Workshops   Sat. Dance   Sun. Dance

First Name:   Last Name:   
 Adult     Young Dancer (under 25)        Subtotal: 
On badge show: First Name:  Last Name:  City:  State:  Custom:

First Name:   Last Name:   
 Adult     Young Dancer (under 25)        Subtotal: 
On badge show: First Name:  Last Name:  City:  State:  Custom:

First Name:   Last Name:   
 Adult     Young Dancer (under 25)        Subtotal: 
On badge show: First Name:  Last Name:  City:  State:  Custom:

First Name:   Last Name:   
 Adult     Young Dancer (under 25)        Subtotal: 
On badge show: First Name:  Last Name:  City:  State:  Custom:

*************************************** Total Amount Due: 


   Send Flyers by  Regular Mail     eMail     No Mailings Please!
    Send me reminders by eMail before dances.
   Address: 
   City:     State:  Zip: 
   Phone:   
   eMail:   
Confirmation requested (stamped, self-addressed envelope enclosed): 
I am willing to help with snacks.  Best day & time:

 YES, I need housing .  Housing is limited; request must be received by 11/19/2011!!
  Min Needs:     Prefer: 
  I prefer: Smoking:    Non-smoking: 
  Allergies/Special Needs: 
  I want to be housed with: