Florida Folk Dance Council, Inc. (FFDC) Proudly Presents:

Florida Folk Dance Camp with Jim Gold and Lee Otterholt

February 20-23, 2004 in Silver Springs, Florida

REGISTRATION FORM (ONE per person please - make duplicates if needed)

Last Name _________________________________ First Name ___________________________

Full Address _____________________________________________________________________

Email _______________________________________ Phone ______________________________

Do you want to receive your monthly newsletter by email? (Circle) Yes No

CAMP FEES:

Full Time (Mark on Left Lines to indicate your choice - Fill in amount of money on Right)

____ ON Campus (Three nights, nine meals) $200.00 ___________

____ OFF Campus (Three nights, nine meals) $150.00 ___________

Part Time

____ ON Campus (Two nights, six meals) $140.00 ___________

____ ON Campus (One night, five meals) $110.00 ___________

____ ON Campus (One night, three meals) $ 70.00 ___________

____ OFF Campus (Two nights, six meals) $110.00 ___________

____ OFF Campus (One night, five meals) $ 95.00 ___________

____ OFF Campus (One night, three meals) $ 55.00 ___________

Rv’s - Off Campus fees as applicable plus a $20.00 fee per vehicle / Tents - Off Campus fee ___________

(Meals are included in the cost of a stay for one day, night, etc. on or off campus, whether

one partakes of them or not. Checking of meals listed below is for kitchen preparation)

Camp Video ................................................................................. $15.00 ___________

Camp T-Shirt (T-shirt design in FFDC Newsletter or at www.folkdance.org) $10.00 ___________

(Circle size & color to order) S M L XL Bright Pink Bright Yellow Charcoal

Contributions to Olga Princi Scholarship are appreciated but not required ___________

Sub Total ___________

If registration for full time is postmarked by January 15th ......... $ 5.00 Minus ___________

If full time & 2004 dues are paid by Jan. 15th (or accompany this form - separate

check for membership: $15.00 single/$20.00 family (2 adults at same address) $10.00 Minus ___________

(Night Party Walk-ins: $10.00 (Students $5) / Student discount of $10 per day Total ____________

Circle the following nights you will be sleeping at Camp: Friday Saturday Sunday

Expect to share cabin with other dancers (8 maximum but "lots" of bath. space / 2 Couples to a Cabin sharing bath

Circle the following meals in attendance (B-Break./L-Lunch/D-Dinner) First meal, "D" on Fri./Last, " L" on Mon.

Fri. D Sat. B Sat. L Sat. D Sun. B Sun. L Sun. D Mon. B Mon. L

Special Diet Preference: Vegetarian Lactose Intolerant Other ________________________

Please Note: Remember that dancing, like any physical activity, can carry the risk of injury. Dancing is on a concrete

floor covered with linoleum tiles. Camp environment is rural with limited lighting. Neither FFDC, Inc., nor its members,

officers or directors have resources to cover costs of any illness or injuries. Your attendance is important to us, but is

also your representation that you have adequate insurance to cover any possible lost wages, medical expenses and/or

pain & suffering without recourse to FFDC, Inc. or its officers and/or members.

Make all checks payable to FFDC and send to: J.P. Miller Questions: Ann Kessler

2006 Oak Street, Melbourne, Fl. 32901 Annie8@aol.com - or - (727) 789-6480