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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.

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

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

 This is a late registration (after ).
 Entire Weekend     Friday Only    Sat. Workshops Only   Sat. Dance Only   Sun. Dance Only
First Name:   Last Name:   
 Adult     Young Dancer (under 25)                   Subtotal: 
First Name:   Last Name:   
 Adult     Young Dancer (under 25)                   Subtotal: 
First Name:   Last Name:   
 Adult     Young Dancer (under 25)                   Subtotal: 
First Name:   Last Name:   
 Adult     Young Dancer (under 25)                   Subtotal: 
First Name:   Last Name:   
 Adult     Young Dancer (under 25)                   Subtotal: 
Total Amount Due: 

Do you want to be on Big Scioty mailing list:  Yes     No.
   Send Flyers by  Regular Mail     eMail
    Send me reminders by eMail before dances.

   Address: 
   City:     State:  Zip: 
   Phone:   
   eMail:   

I am willing to help with snacks.  Best day & time: 
Confirmation requested: Stamped, self addressed envelope enclosed: 

YES, I need housing .  Housing is limited; request must be received by 17.Nov!
  Sleeping bag space OK for .
  Prefer bed space for .
  Type and number of beds needed (twins, double, etc.) 
  I prefer: Smoking:    Non-smoking:    Pets OK: 
  Allergies: 
  Special Needs: 
  I want to be housed with