Red & White

Payment Summary Form Dance Showcase

Entry Deadline: February 12, 2011 Saturday, February 19, 2011

Registration Fees In Advance After 1/19

Adult Total #____X $20
Registration Fee #______ X $15per person = $________
One per student Includes 1 admission ticket, snacks, & $ = $______
program
Youth / College Total #____X $10
Registration Fee #______ X $5 per person = $________
One per student Includes 1 admission ticket, snacks, & $ = $______
program
Adult Pro-Am Freestyle Fees
Adult Total
Pro-Am Freestyles # X $8 per dance = $ $
Adult Solo or Total
Formation Routines # X $16 per dance = $ $
Adult Amateur Freestyle Fees
Adult Total
Amateur Freestyles # X $8 per dance = $ $
Youth / College Pro-Am Fees
Youth Total
Pro-Am Freestyles # X $6 per dance = $ $
Youth Solo or Total
Formation Teams # X $11 per dance =$ $
Youth / College Amateur Freestyle Fees
Youth Amateur Total
Freestyles # X $3 per dance = $ $
Admission Tickets
Adult Total
Admission # X $10 per person = $ $ # X $5 = $
Youth Admission Total
18 & under # X $5 per person = $ $

Grand Totals Advanced Late

$ $
Payment Information
Name Phone

Address City Zip

Credit Card Number: Visa or Exp.

MasterCard
Check # Amount Enclosed #

Red & White Dance Showcase

Bluegrass Dance Center * 2187 Lexington Rd. * Building B, Suite 3 * Richmond, KY 40475
Studio: (859) 625-9393