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2nd Annual LITMA Music & Dance
Jamboree Registration Form
SATURDAY, NOVEMBER 18, 2006
Please Print: (Include ALL first and last names of people registering.
Use one main address for more than one person registering. This form may
be duplicated.)
Name(s) ____________________________________________________
Addıl Name(s) ______________________________________________
Address __________________________________________________
City____________________State__________Zip_______________
e-mail_____________________________ Tel. (____)_____-________
Jamboree Fees - Postmarked by Nov.6: No. of people total amt.
$30 LITMA members ($35 after Nov. 6 by phone) X ________ = $__________
$35 non-members ($40 after Nov.6 by phone) X ________ = $__________
Special fee for workshop leaders, musicians, callers, sound system
personnel (pre-arranged with Bernie) X ________ = $__________
Grand total = $__________
O Check enclosed (made out to LITMA)
O Mastercard O Visa #____________________________ Exp. Date_______
Name as it appears on card (Please Print)_____________________________
Signature (if paying by charge card): _______________________________
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