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Jack & Jill O'Rama 2012 Registration Form |
For Mail; Please Print, & Fill Out Completely Online Registration is Available on the Website |
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| Name: | |
| Address: | |
| City, State, Zip: | |
| Phone: | (Day)_______________________(Eve)_______________________ |
| E-mail: | |
| Amount enclosed: | |
| Visa/Mastercard# | _______________________________________ Exp.date_________ CCN_________ |
List Attendees:
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List Junior Attendees (If any)
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Mail To: Central Coast Swing Dance 333 Rice Ranch Rd. Santa Maria, CA 93455 Phone (805) 937-1574 Registration E-Mail: ccsd@thegrid.net |