<p> AtlantaAtlanta All-StarAll-Star SwingSwing FlingFling August 13-15, 2009 Event Registration Form Please complete this form. There are NO REFUNDS.</p><p>Name: ______Name: ______Address: ______Address: ______City: ______State: ____ Zip: _____ City: ______State: ____ Zip: ______Phone: ______Email: ______Phone: ______Email: ______</p><p>Submission of this form by the party or parties listed above signifies the following statement: “I/We agree to hold the organizers of this event and their agents harmless from all suits, claims or demands of every kind and character arising out of and in conjunction with this event. I/We hereby authorize the reproduction, sales, copyright, exhibition, broadcast, and/or distribution of any event videotape without limitation. I/We understand the physical risks of entering dance competition and social dancing and assume full responsibility for any injury or personal damages resulting from the event named above. I/We certify that we are 18 years or older (applicable to Legal Guardian if under 18 years of age).”</p><p>Signature Date Signature Date</p><p>Event Fees</p><p>Weekend Pass……………………………… ____ x $85.00 ($75 before July 28) = $______(Includes all workshops and both night’s dances)</p><p>Saturday Pass……………………………… ____ x $60.00 ($50 before July 28 ) = $______(Includes all workshops on Saturday and Saturday night dance)</p><p>Friday Dance………………………………. ____ x $10.00 = $______(Includes the Friday Night Dance Only)</p><p>Saturday Dance…………………………… ____ x $20.00 = $______(Includes the Saturday Night Dance and Show Only)</p><p>Video Pass (bring your own camera)……… ____ x $20.00 = $______</p><p>Video Notebook (we film it for you)……….... ____ x $30.00 = $______EVENT FEES TOTAL ……………………………………………………………………. $______</p><p>Individual workshop tickets for Friday may be purchased at the event for $10.00 per hour. Saturday workshops only available with Weekend or Saturday Pass.</p><p>Please make checks payable to: Bill Robinson</p><p>Mail Registration Forms & Payment to:</p><p>Debbie Robinson 1911 Grayson Hwy Suite 8334 Grayson, GA 30017</p><p>Please send check or money order. We are not set up to accept credit cards.</p><p>Registration forms must be postmarked by July 28, 2009. If not mailed by July 28, please register at the event @ increased price.</p>