Fall Challenge Weekend Application

September 30 - October 2, 2011

Name(s):
E-mail address (printed so I can read it):

Per person (circle 1): Single Double Triple
Private Bath Semi Private Private Bath Semi Private Private Bath Semi Private
MIT Undergrad $228 $225 $100 $80 $100 $80
Dancer $228 $225 $180 $177 $166 $164

Ask me about rates for non-dancers, kids (dancing or not), babies, etc.

Read this statement and initial here _____ I (we) understand that there is a chance the weekend may be cancelled at the last minute. Were this to happen, Clark will refund all my money less $5 (for John's plane fare).

Check (or circle) the statements which apply:

Sharing room with: ______________________________________________________________________

Highest level: Squares: ____________ Rounds ___________

Please write suggestions for Saturday morning and afternoon dance activities on the back or e-mail Clark.

A deposit of $50 per person is due by 8/30/11. Make your check payable to Clark Baker and either give it (and this form) to him at dancing on Tuesday, or mail them to 426 Marsh St., Belmont, MA 02478-1109. The balance is due by 9/20/11. If you can pay in full when you send in your deposit, it will make things a little easier.

Revised: $Date: 2011/06/02 15:19:01 $