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.