STEVEN & VIRGINIE in CHICAGO
REGISTRATION PAGE:

Step 1 of 2
Step 1 = INFORMATION
Step 2 = PAYMENT

BACK TO REGISTRATION INFORMATION

FIRST NAME: 
LAST NAME: 
EMAIL:
LEADER or FOLLOWER: 
CITY: 
STATE: 
HOW LONG HAVE
YOU BEEN DANCING:
     CAN YOU HOST?
     HOW MANY PEOPLE?
     DO YOU NEED HOUSING?
REFERRAL:
OTHER REFERRAL:
ARE YOU ATTENDING and THE SATURDAY DANCE? - PAY IN STEP 2
PAYMENT METHOD: - PAY IN STEP 2

By clicking SUBMIT FORM, you agree to the following:
On behalf of my heirs, I agree to forego, expressly waive and release any/all rights for damages that I or my heirs might have against the Steven & Virginie in Chicago event, 2PlySwing, the Galaxie or its agents for any/all injuries and damages I might suffer by participating in the this event or in traveling to and from its locations.  2PlySwing, the Galaxie and/or teachers cannot be held responsible for any accident, injury or loss of property that may occur during this dance event.
I understand and agree that any reproduction of my image on film or in video can be used freely by any of the above mentioned entities.

By clicking SUBMIT FORM, you agree to the REFUND POLICY:
              100% if cancelled by SEPTEMBER 30
              50% if cancelled by OCTOBER 15
              No Refunds after OCTOBER 15