SWING RIOT 2001 REGISTRATION FORM

Name _________________________________________________

Address ______________________________________________

City, State, Zip __________________________________________

Email ________________________________________________

Phone Number _________________________________________

I am a: _____ Lead ______ Follow

I am a:_____ Beginner/Intermediate_____ Intermediate _____ Intermediate/Advanced _____ Advanced

I heard about the Riot from: __________________________________________

Sign me up for the weekend:
$140 if postmarked or hand-delivered before February 1, 2001.
$160 After February 1st

___ I am a member of A.S.S., H.S.D.S., D.S.D.S., S.A.S.D.S.
and entitled to a $10 discount on the above price.

$____________
Sign me up for the dance contest at $10 per partner.:

My partner's name is ____________________________.

Total included: $_______________________

After completing this form, Please include your check or money order
(Please, no cash by mail) made payable to: Four on the Floor

Please return your registration form and payment to:
Matt Jones
7802 Rutgers Avenue
Austin, Texas 78757