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Percy Thornton Foundation Workshop Registration Form
Sunday, July 13 and August 10, 2008 from 2-4 pm
Mint Julep's, 155 Hall Av.,
Southern Pines, N.C.
Female Participant Name:______________________________________
Male Participant Name:________________________________________
Adult Contact Name:_______________________Phone____________________
I am registering for: (circle all that apply)
The July 13th Workshop ( 7/13/08 ) on Sunday afternoon beginning at 2pm
The August 3rd Worhshop ( 8/10/08) on Sunday afterniing beginning at 2pm
Female: ______________years of age Male: _____________________years of age
ALL STUDENTS MUST BE ACCOMPANIED BY AN ADULT
Registration Fee is $5.00 per student or $8.00 per male/female partners
Payable in CASH at the door
or use the Pay Pal button below for credit card payment
Mail Registration form to:
The Percy Thornton Foundation
Dance Workshop
105 Barvis Circle
Southern Pines, NC 28387
OR
Call 692-9889 if you need additional information |
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