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Last NameHisHers

Street Address

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Number for Dinner/Dancing 1 for Dinner and Dancing ($35) 2 for Dinner and Dancing ($70) 1 for Dancing Only ($15) 2 for Dancing only ($30)  

After submitting the form above:

Payment for dinner/dancing is $35 per person advance registration till December 15, 2011

Payment for dancing only is $15 per person advance registration till December 15, 2011 ($20 at the door)

No Refunds on meals after December 15th, 2011.

Mail Payment as on the flyer