RESERVATION FORM

Reservation for January and or March

 

(Print  & mail form or mail same information with your check.  Thanks)

Advanced Dance Reservation Form

Total Cost $40 prepaid   Walk-ins Per session $16 per couple
Three Sessions:    10 a.m -- 2 p.m --  7 p.m.
​Please indicate which dance by circling the date:


Jan 19, 2019 with Keith & TBA  @ Lake Ashton
March 21, 2019 with Keith & Ron Libby @ Lake Ashton

Return reservation with $20 deposit & checks payable to:
Keith Stevens 4356 Ashton Club Dr. Lake Wales  FL   33859

Email is the preferred method of communication.  Provide email address

PLEASE PRINT CLEARLY

Dancer # 1:                                                                                                                            

Street Address:                                                                                                                  

City:                                                                                                           Zip                                                                                                                   


Email Address     

Dancer # 2: 


Street Address:                                                                                               

City:     Zip  

Email Address:    ​