JUNE 2013 - Western New York Cloggers Association by dagedaer

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									          2013 Nickel City Clogging Festival Registration Form
Last Name
First Names       1                                                                    2
                  3                                                                    4
Team Name
Email Address
Address
City, St Zip
Phone
   TO BE ELIGIBLE FOR THE WNYCA MEMBER DISCOUNTS, REGISTRANTS' DUES MUST BE PAID THROUGH
                                                            JUNE 2013.
Quantity          Description                                                                Price    Subtotal
                  Workshop Dancer (postmarked by April 1)                               $    28.00
                  WNYCA Member Dancer (postmarked by April 1)                           $    18.00
                  Dancer After April 1
                  (If Postmarked after APRIL 1, no guarantee on syllabus and apparel
                  orders. Member discount valid only until April 1)                     $    35.00
                  Spectator                                                             $     5.00
                  Video Registration (All videotaping of instructional classes
                  requires video tag. This includes cameras, smart phones, and
                  tablets/IPads).                                                       $    10.00
                  Syllabus on CD -- Workshop Dancer
                  (Advanced Order Price Only. At door, a limited number of syllabi
                  will be available for $10.)                                                $8.00
                  Syllabus on CD -- WNYCA Member                         (Advanced
                  Order Price Only)                                                          $7.00
                  Syllabus Book -- Workshop Dancer                           (Advanced
                  Order Price Only. At door, a limited number of syllabi will be
                  available for $10.)                                                  $      8.00
                  Syllabus Book -- WNYCA Member                             (Advanced
                  Order Price Only)                                                    $      7.00
                      WNYCA Members: Enter Total # Shirts to
                      Receive $2/Shirt Discount (Advanced Order Only)                   $    (2.00)
                            Credit Card Convenience Fee                                 $     2.00
                                Total Buffet Order (From Page 2)
                               Total Apparel Order (From Page 2)
                                                Total enclosed
                           ***NEW*** PAY BY CHECK OR CREDIT CARD
                              $2.00 CONVENIENCE CHARGE APPLIES
                                 CHECKS MUST BE IN US FUNDS
              Make Checks payable to: Western New York Cloggers Assoc., Inc. (WNYCA, Inc.)

                                 If paying by credit card, please complete the following:
                      _______ Visa _______ Mastercard _______ Discover _____ American Express
Name on Card
Card Number
3/4 # Auth Code                                                                        Exp Date

 Signature

                          Mail to Linda Haley, 9685 East Holland Road, Holland, New York 14080
                                    Nickel City Clogging Festival Registration Form Pg. 2
   APPAREL ORDERS: To order Nickel City shirts, enter the quantity of each each color, size, and style you would like to order, and then total dollar
   amount in the Totals Column. NOTE: THERE WILL BE A VERY LIMITED QUANTITY OF SHIRTS AVAILABLE AT THE DOOR.
                                                                                                                                                              Adult XXL       Adult XXXL
                                                              Youth                                                                                            (+$2 per        (+$2 per
                                              PRICE          Medium        Youth Large      Adult Small Adult Medium Adult Large Adult X-Large                   shirt)          shirt)           TOTAL
   T-Shirt PURPLE                              $12.00
   Long-Sleeved T-Shirt                        $15.00
   Zippered Hoodie                             $28.00

   TOTAL COST OF APPAREL ORDER                                                          WNYCA MEMBERS RECEIVE A $2.00 DISCOUNT PER SHIRT.
   TOTAL # OF APPAREL ITEMS                                                   PLEASE ENTER THE TOTAL NUMBER OF SHIRTS ORDERED ON THE FIRST PAGE, AND
                                                                                                ENTER YOUR TOTAL DEDUCTION THERE.
 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

   EXHIBITIONS: To exhibition on Saturday night, all dancers must be workshop registered. Tell us the team name and contact information.
   You will be contacted by Patty Gunner of the WNYCA with further details. NOTE: Exhibitions must have a minimum of 3 dancers; limit 1 song per
   exhibition.
   Name                                                                                                           Phone
   Contact                                                                                                         Email

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   BUFFET RESERVATIONS: Buffet Dinner is PRE-RESERVATION ONLY. Tickets will be provided in your registration packet. Cash bar will begin at
   5:00 p.m. and dinner will commence at 5:30 p.m.
                                                                                                                                                            Number of Tickets                Total Cost
   Last Name:
           ____________________________________                                                Adult Tickets:                 $20.00              X                                =

   First Name:
            _____________________________________                                             Kids (under 10)                 $10.00              X                                =

                                                                  INDEMNITY CLAUSE/ RELEASE OF LIABILITY
    The Adam's Mark Buffalo, Nickel City Clogging Festival, Western New York Cloggers Association, Inc. (WNYCA), and the Nickel City Festival committee
   and staff, including but not limited to volunteers, vendors, instructors, and demonstrators, assume no responsibility for damages or injuries suffered by any
     participant, including but not limited to dancers and spectators. By registering, and in consideration of the acceptance of your participation herein, all
     participants and their parents, guardians, and/or chaperones agree to assume all risks of injury to the participant's person and property resulting from,
         caused by, and/or connected with the events of the Nickel City Clogging Festival, and to release and hold harmless any and all claims which the
   participant may have against the Adam's Mark Buffalo, the Nickel City Clogging Festival, WNYCA, the Nickel City Festival committee and staff. Workshop
                     applications are accepted only upon the acceptance of all conditions listed herein and rules set forth at www.wnyca.com.

								
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