Love 2 Dance

Love2Dance Fest, January 30th-February 1st, 2009

Please complete the entire form below and you will be receiving a confirmation e-mail very soon after. Your Registration Package will be waiting for you when you arrive at the event.

Note: All prices will be increased after January 1, 2009
(please fill out a separate registration form for each person)

E-mail: (required)

Name: (required)

Street Address:

Any Additional Address Information:

City:

State/Prov:

Zip/Postal:

Home Phone:

Business Phone:

Mobile Phone:

Fax Number:

Verify E-mail:

Event Title:

Love2Dance Fest Available Event Passes
(please choose from the selections you see below)

Note: Senior Discounts available on Weekend Pass only!

Weekend Event Pass $80.00 (Includes all workshops and evening dances.)
Senior Weekend Event Pass (Age 62+) $70.00 (Includes all workshops and evening dances.)
JR Weekend Event Pass (Age 14 & under) $55.00
Friday Only Pass $45.00 (Includes workshops and night dances on FRIDAY ONLY.)
Saturday Only Pass $55.00 (Includes all workshops and night dances on SATURDAY ONLY.)
Saturday & Sunday Pass $65.00 (Includes workshops and Saturday night dance)
Friday OR Saturday Evening Dance Pass $10.00
Spectator Pass (All Weekend) $25.00
Video Camera Pass $30.00 (Bring your own camera)

Optional Items Available For Purchase
(please select yes or no for the items below)

Step Description Booklet	Yes $25 No
DVD	Yes $50 No

NO REFUNDS ~ NO REFUNDS ~ NO REFUNDS

* * VERY IMPORTANT: You may pay for more than one person, or someone may pay for you. However each person attending must fill out a separate registration form. If you answered 'YES' to one of the 2 questions below, please enter the names in the box below so that Carolyn & Rick know who belongs together. If you answered 'NO' to both questions then go right to the Disclaimer part!

* If you are paying for someone, please answer 'YES' to the first question and 'NO' to the second question. Please enter that person's name in the box below. Please fill in the Disclaimer box, and then complete the payment section!

* If someone is paying for you, please answer 'NO' to the first question and 'YES' to the second question. Please enter that person's name in the box below. Please fill in the Disclaimer box, and you can skip the payment section!

Are you paying for more than one person? Yes No

Is someone paying for you? Yes No

Please list their names:

(Each person MUST fill out a separate registration form)

* * VERY IMPORTANT: You must read & agree to this Disclaimer to register: “I 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 hereby authorize the reproduction, sale, copyright, exhibition, broadcast, and/or distribution of any videotape without limitations. I understand the physical risks of entering social dancing and assume full responsibility for any injury or personal damages resulting from the event named above. I certify that I am/are 18 years of age or older (applicable to Legal Guardian if under 18 years of age)”. The state of South Carolina policy prohibits alcohol in public areas (workshops & evening dances). I understand and agree to purchase alcoholic beverages at the hotel bar in order to bring them into the evening dances. I agree with the statements above and adhere to them.

Do you agree to the terms of the disclaimer?
You must type in Yes I Agree in the box above for the form to process!

Check Payment Method
Check Number:	Total Amount:

If you are choosing to pay by check, after you complete this form, we ask that you please make out and mail your check to: Love2Dance, Inc., 729 Dove Haven Lane, Myrtle Beach, SC 29579

Credit Card Payment Method
(if you're using a credit card please choose from below)
Master Card Visa Discover Telephone

You may also pay with a Credit Card by telephone - (843) 903-3851. Just fill out the online form but leave the credit card information empty. Then give Carolyn & Rick Robinson a call and give them your credit card information over the telephone. Please select 'Telephone' as your choice above and call Carolyn & Rick ASAP

Bank Card Type: Credit Debit
Card Number:	Exp. Month:	Year:
Exact Name on Card:		SVC #:
Total Amount On Card:

Please be sure that the mailing address you entered above is the actual correct mailing address for the bank card you are using! The address needs to be correct in order for the card transaction to process!

The e-mail that is created and sent by this form goes to E-mails Servers that are H.I.P.A. (Health Information Protection Act) compliant. H.I.P.A. requirements insist that there be a 128 bit encryption in all e-mails coming and going from the servers.

* * Important Note:
Clicking on the 'Submit to Love 2 Dance' button will send an e-mail to Love 2 Dance at this address: . Then you will be taken to a 'Online Confirmation' page. If none of this occurs then the information was not sent to Love 2 Dance. At this point you can either try to submit the form again or please contact Rick & Carolyn Robinson directly either by using this e-mail address: or pick up the the phone and call them: (843) 903-3851