| FULL NAME: * |
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| ADDRESS: * |
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| CITY, STATE, ZIP |
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| HOME PHONE: |
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| CELL PHONE: * |
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| EMAIL ADDRESS: |
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| EMERGENCY CONTACT NAME * |
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| EMERGENCY CONTACT PHONE #: * |
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| 2ND EMERGENCY CONTACT NAME (OPTIONAL): |
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| 2ND EMERGENCY CONTACT PHONE # (OPTIONAL): |
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PACKAGE
SELECTION |
PACKAGE 1: $399 - 2 IN A ROOM
PACKAGE 2: $389 - 3 IN A ROOM
PACKAGE 3: $369 - 4 IN A ROOM
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I WILL BE ROOMING WITH:
(PLEASE PROVIDE FIRST AND LAST NAME) |
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| GUEST #2: |
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| GUEST #3: (IF APPLICABLE) |
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| GUEST #4: (IF APPLICABLE) |
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| WHO DID YOU PAY YOUR DEPOSIT TO: |
WEBSITE
JEANNETTE
TRACEY RHODES
DJ CHRIS BLUES
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| AMOUNT PAID WITH FORM: * |
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| METHOD OF PAYMENT |
CREDIT CARD
CHECK
MONEY ORDER
CASH |
TRAVEL OPTION
(PICK-UP LOCATION) |
OXON HILL PARK & RIDE, OXON HILL, MD
WHITE MARSH MALL PARK & RIDE - BALTO, MD
30TH & MARKET STREETS - PHILA, PA
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TRAVEL OPTION OTHER
(I.E.CAR, AIRPLANE, ETC): |
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| HOW DID YOU HEAR ABOUT THE SKI TRIP? |
WEBSITE: www.discosistasandcompany.com
DISCO SISTAS 2ND SUNDAYS LINE DANCE SOCIAL / TRACEY & JEANNETTE
PARKSIDE / DJ CHRIS BLUES
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