CDSS Summer Program Registration Form

Country Dance and Song Society
PO Box 338/132 Main St
Haydenville MA 01039-0338

Summer Camp Registration Form 1999
Phone: 413-268-7426 ext. 3; Fax: 413-268-7471
Email: ; WEB: www.cdss.org/programs

please number in order of preference

Pinewoods Camp
__ Early Music Week
__ Folk Music Week
__ Storytellers Course
__ Family Week
__ American Dance & Music Week
__ Campers' Week
__ English & American Dance Week
__ American Dance Callers Course
__ English Dance Week

Buffalo Gap Camp
__ Dance Week
__ English Dance Musicians Course
__ Family Week

Ogontz Camp
__ Family Week

I/We would like to attend a total of __ weeks

Use this section for first or only adult on the registration.

Name:_____________________________Age______M/F_____
Address:____________________________________________
___________________________________________
City/State/Zip:_______________________________________
Phone Home:__________________work:________________

__ I do __ do not want my home phone included on the camper list
__ I prefer meat __ vegetarian menu
__ I do not __ do have food allergies
__ I am not __ am a smoker
For Early Music Week and English Dance Musicians Course only
My main instrument is:________________________

My roomate/housing preferance is _________________
My camper job preferance/limitation is: ___________
__ Send work scholarship information
__ I can offer __ I need a ride to camp from ___________

MEMBERSHIP:
I'll join up or renew! I have enclosed my dues.
___$35 Individual ___$25 Limited Income Ind
___$50 Family ___$35 Limited Income Family

__ Don't publish phone in next Members List
__ Don't share address with other groups
__ Do include e-mail in next Members List

Email: _____________________________

All confirmation information will be sent to the address listed above.
Please do provide the address for all registrants.

My camper job preferance/limitation is: _____________
__ Send work scholarship information
Comments:

PAYMENTS:
_____ Deposit of $100/person/week or full payment
_____ Contribution to Scholarship fund
_____ CDSS membership

___________ Total paid

CREDIT CARD PAYMENTS:
___VISA ___MasterCard. Exp. Date ________

Card No. ____________________________

Cardholder's Signature _____________________

FOR OFFICE USE ONLY

App	Tot	Due
St	Wk	$
Sch	Wk	$
Rides	Memb	$
Gen Fam	Sch	$
Parents	total	$
#	DATE

Use this section for childres (give full names and ages at time of camp.)
Please add addressess and phone if different than the first section.

Name 3:____________________________Age______M/F_____

Name 4:____________________________Age______M/F_____

Name 5:____________________________Age______M/F_____
Comments: