Winter Council 2003 and Dance/USA on Tour New Orleans Registration Form

Name: ______________________________________________________
Title: _____________________________________________________
Organization: _______________________________________________
Address: _______________________________________________
City/State/Zip+4: ______________________________________________
Tel.: _____________________________________ Fax: ______________________________
E-mail: _____________________________________

Sign me up:

Dance/USA on Tour - professional development workshop (Thurs., Jan. 30)
___ Dance/USA rate, $25 (includes catered lunch)

Winter Council Pre-Registration, received by January 24
___ Dance/USA member, $90
___ Non-Member, $110
Winter Council Registration after January 24:
___ Dance/USA member, $100
___ Non-Member, $120

I will be attending (check one):
___ Artists Council (Modern/Other Genre)
___ Managers Councils (___ Large Ballet; ___ Small/Medium Ballet; ___ Modern/Other Genre)
___ Presenters Council
___ Service Organization

___ Yes ___ No (check one) I will be attending the offsite reception Thursday evening, Jan. 30

I would like to buy ___ (number) of tickets for the performance of Complexions on Saturday evening, Feb. 1, at $_______ each [$37.50, balcony; $45.50, orchestra] for a total of $_______. (Price includes bus transportation to the concert.)

Send check (in $US) or pay by credit card.
Type of Credit Card (check one): ___Mastercard ___ Visa ___ American Express
Card Number: _________________________________ Expiration Date: _____________
Name as it appears on the card: ___________________________
Signature:_____________________________________________

Total Amount to be billed to credit card or enclosed: $_____________

Make check or money order payable to Dance/USA in US dollars. Please return this form with payment (to be received by January 24, 2003) to: Dance/USA Winter Council, 1156 15th Street NW, Suite 820, Washington, DC 20005-1726 or fax to: 202/833-2686.

Questions? Contact danceusa@danceusa.org.