Jack & Jill O'Rama 2007 Registration Form

	Jack & Jill O'Rama 2007 Registration Form
	For Mail; Please Print, & Fill Out Completely E-Mail: (credit card only) Copy & Paste, Fill out completely
Name:
Address:
City, State, Zip:
Phone:	(Day)_______________________(Eve)_______________________
E-mail:
Amount enclosed:
Visa/Mastercard#	_______________________________________ Exp.date_________

Jack & Jill O'Rama is $115 when postmarked by May 24, 2007
$130 per person at the door
No refunds or substitutions

Central Coast Swing Dance, 333 Rice Ranch Rd, Santa Maria, CA 93455 Phone (805) 937-1574

Registration E-Mail: ccsd@thegrid.net

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