<p> Canadian Open Square, Step Dancing & Clogging Competition 2017 Fiddle Entry Form Please enclose entry fee</p><p>Name of Fiddler: ______City/Town: ______</p><p>Contact Name: ______</p><p>Address of Contact: ______</p><p>Postal Code: ______Phone number: ______</p><p>Email address: ______</p><p>Make prize winning cheque payable to: ______</p><p>Entry Fee Names and Ages of Fiddler</p><p>Under 18 years …….………….$5.00 (……) ______(under 18 years by June 30th;) Date of Birth:</p><p>______18 Years and Over ……………..$5.00 (……) (18 years by June 30th; ) ______</p><p>______</p><p>______</p><p>Total amount of entry fee enclosed: ______</p><p>List any fiddler competing in other classes: ______</p><p>______Make cheques payable to Dundalk Dance Association</p><p>I agree that group and/or individual photography may include the image of the participant(s) named below for promotional purposes only.</p><p>Signed:______Date:______</p><p>Send entries to: Dundalk Dance Association, Office Use Only P. O. Box 352, Dundalk, Ontario N0C 1B0 □ Payment Received Phone: (519 )923-3406 □ Confirmation Sent Email:[email protected] □ Program Addition www.facebook.com/dundalkdanceassociation</p>