Winter WarmUp 2016 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.

Postmark your registration by Nov 19, 2016 to receive the early registration discount!

A limited number of working scholarships are available. Contact Martha Shaw (614-562-4974) by if you are interested.

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

Refund policy: Full refunds available through 21.Nov. From 22.Nov to the beginning of the dance, refunds will be granted, minus $20.

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

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

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


First Name:   Last: 
 Adult     Young Dancer (26 and under)    Subtotal: 

On badge show: First Name:  Last Name:  City:  State:  Custom:


First Name:   Last: 
 Adult     Young Dancer (26 and under)    Subtotal: 

On badge show: First Name:  Last Name:  City:  State:  Custom:


First Name:   Last: 
 Adult     Young Dancer (26 and under)    Subtotal: 

On badge show: First Name:  Last Name:  City:  State:  Custom:


First Name:   Last: 
 Adult     Young Dancer (26 and under)    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 can help with snacks.  Best time: 

YES, I need housing .  Housing is limited; request must be received by !!

  Min Need:   Prefer: 
  I prefer: Smoking:    Non-smoking: 

  Allergies/Special Needs: 
  I want to be housed with: 
  I'm willing to host!  I can provide: 
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