2003 Newport Dance Week REPLY FORM

Name as you would like it on your badge:   
 
Full Name:   
 
Street Address   
 
   
 
City   
 State   
 ZIP   
Phone (day)   
 (eve)   
E-mail   
 
 
I. Address List
Would you like either your e-mail and/or phone number listed on the participant address list given to all participants?
Check one, both, or none:  [  ] e-mail      [  ] phone      [  ] none     
 
II. Transportation
I plan to arrive on (Sun or Mon)  
 
 at (approx time)   
I will arrive by (car, plane, carriage,...)  
 
 Flight (if plane)   
Car info, if driving (make, model, color,license plate #)  
 
 
III. Room Assignment:
  [  ] I requested a Double Room
          [  ] My preferred roommate is:   
          [  ] Please assign me a roommate
  [  ] I requested a Single Room
 
Any special requests? (room near friend, etc.) we do our best to meet requests, but cannot guarantee they will be met.
 
 
IV. Medical Information:
There will not be medical personnel on staff, but if you have any condition that we should be aware of, please indicate it here.
 
 
 
V. Liability release:
I acknowledge that my participation in the Newport Vintage Dance Week is voluntary. I will not hold the Commonwealth Vintage Dancres, the instructors, or the Portsmouth Abbey School responsible for any accident that may occour as a result of my participation.
 
Sign Name:   
 
Print Name:   
   Date:   
 
VI. Photograph Release:
[  ]  I GIVE permission for CVD to use my image in photographs taken at this event for future dance week brochures and on the CVD website.
 
[  ]  I DO NOT GIVE permission for CVD to use my image in photographs taken at this event for future dance week brochures or on the CVD website.
 
Sign Name:   
 
Print Name:   
   Date:   
 

Please complete this form ASAP and return it to:

Newport Vintage Dance Week
Attn: Hannah Roberts Artuso
99 Malvern Street
Melrose, Massachusetts 02176

Return to the Newport Vintage Dance Week brochure.
Visit the Commonwealth Vintage Dancers' Home Page.

Last updated 28 July, 2003/csb