advanced dance RESERVATION FORM 2020

Reservation for January and or March

 

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

January 18, 2020 dance with Betsy Gotta  & Keith

                                       

March 21, 2020 dance with Ron Libby & Keith

Total Cost $40/couple  prepaid   Walk-ins $16 per couple per session.

Three dance sessions    10 a.m -- 2 p.m --  6 p.m.
The early evening dance hour allows early departure for home after the dancing.   

​Please indicate which dance by circling the date above.  Circle both for two dances.   

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

Email is the preferred method of communication. 

PLEASE PRINT CLEARLY


Dancer # 1: _____________________________________  


Street Address: _____________________________  


City/State:  _____________________         Zip  _________ 


Tel #___________________


Email:     _______________________________________ 


Dancer # 2:   _____________________________________ 


Street Address:  ________________________________   


Cit/State:   ___________________________Zip _________ 


Tel #___________________

                                                                                          

Email:   __________________________________________