REGISTRATION FORM for Brenda and Tony Balboa Weekend

Please Print and Mail to:    
Francois Piche
730 6th Street
Verona PA 15147

Make checks payable to “Coal Country Traditions”.


Please check the workshops you are registering for:

Pricing
  Regular Student
Weekend package
(Fri evening workshop and dance, Sat workshops, Sun workshops)
$70 $50
Saturday package
(Fri evening workshop and dance, Sat workshops)
$40 $30
I have enclosed

 

I have enclosed $_________

Name ____________________________________

Address ____________________________________

City _________________ State ______ Zip ________

Phone (eve.) __________________

Phone (day) ___________________

Email _______________________________________________