Richard Powers' Split Tree Waltz Weekend

 On-line Registration Form

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If entry is n/a or zero, please just leave it blank - except for the required fields

* = required field

Today's Date:

* (mm/dd/yy)

Name 1

*

Email:

*

Name 2

Name 3

Name 4

Street/Box *

City * State *  Zip *

Phone: ( *) *- * 

 
*# Dancers @ $ 75 ea; $85 after Oct. 18  
*# Meal Tickets @ $ 25/person; deadline Oct. 28  

# "Waltzes" CD @  $ 10 ea

 
# House single beds - $20/person/night  
Your total is:  

Total Amount being paid (either check or credit card): (STF)  $ * 

How Paying?* Credit Card   Check - Make check payable to Split Tree/WW2002

Online credit card payment is available at the Split Tree Web Store

Please note:  Credit refunds only after Oct. 18, 2002

Lodging plans (indicate # of people beside your choice of a place to stay other than in house):

wanting Barn space (a mattress of wood shavings)

# wanting Pasture tenting

# wanting Motel/BnB, see housing page below

# wanting Studio/house floor space

# wanting house bed Please indicate where
 
Click here for nearby lodging with special rate at Key West Inn;  individual reservations only.

Questions:  Send note in space below or call us at 706/539-2485 or email registrationwaltz02@splittree.org.