CDSS Summer Program Registration Form

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

Summer Camp Registration Form 2000
Phone: 413-268-7426 ext. 3 - Fax: 413-268-7471
camp@cdss.org - www.cdss.org/programs
Registration Info

please number in order of preference

Pinewoods Camp
__ Early Music Week
__ English Dance Leaders Course
__ Folk Music Week
__ Family Week
__ American Dance & Music Week
__ American Dance Callers Course
__ Campers' Week
__ English & American Dance Week
__ American Dance Musicians 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 Musician Courses only
My main instrument is:________________________

My roommate/housing preference is _________________
My camper job preference/limitation is: ___________
__ I have enclosed a scholarship application
__ I can offer __ I need a ride to camp from ___________

MEMBERSHIP:
I'll join up or renew! I enclose my dues.
___$35 Individual ___$25 Limited Inc Ind
___$50 Family ___$35 Limited Inc Fam

__ 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 preference/limitation is: ___________
__ I have enclosed a scholarship application
Comments:

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

___________ Total paid

CREDIT CARD PAYMENTS:
___VISA ___MC Exp. Date __________

Card No. ____________________________

Cardholder's Signature _________________

Charge my card when balance is due _____

FOR OFFICE USE ONLY

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

Use this section for children (give full names and ages at time of camp.)
Please add addresses and phone if different from the first section.

Name 3:____________________________Age______M/F_____

Name 4:____________________________Age______M/F_____

Name 5:____________________________Age______M/F_____
Comments: