1^st Annual River City Swing Fling

  East Coast, West Coast Swing and Bop

  March 24^th 2012

   V.F.W. Post 1114 – 110 N. Wabash Av. Evansville, Indiana

Name(s)___________________________________________  # of tickets_______ x $20  $_________

 

RELEASE FROM LIABILITY AND AUTHORIZATION. Please read carefully and be aware that, in

signing up and participating in the above program, you will be waiving and releasing all claims for injuries, arising out of

this program, that you or the above participant might sustain. I do hereby fully release and discharge The ERC BOP Club

Workshop, its officers, agents, servants and employees from any and all claims from injuries, damage or loss which I may

have or which may accrue to me on account of my participation in the above The ERC BOP Club Workshop sponsored

activities.  I further  agree to indemnify and hold harmless and defend The ERC BOP Club Swing Fling, its officers,

agents, servants and  employees and all claims resulting from injuries, damages and losses sustained by me and arising

out of, connected with, or in any way associated with these activities sponsored by The ERC BOP Club Workshop.

I also grant permission to use my  picture/image on the website and/or advertising for The ERC BOP Club Swing Fling.

SIGNATURE___________________________________________________________________Date______________

 

Print Name__________________________________________________________________________
                        (PRINT IN UPPER CASE LETTERS)
Address: ____________________________________________________________________________

 

City_________________________________________ State________________ Zip Code____________

 
EMAIL _____________________________________________________________________________

Phone: Home:______________________ Cell:_____________________ Emergency:__________________

 

PLEASE MAKE CHECKS PAYABLE TO THE ERC BOP Club.   

                                                             

Send checks to:   Sue Stanley                             

1721 Arrowhead Drive

Boonville, IN 47601    

               

$20 per person prior to February 25th  after that $25 per person.  

                                  

REFUND POLICY and MISSED CLASSES: Registration Fees are non-refundable.