Online Registration Demo MAX
Online Registration

View the Paid Registration Names: Click
View/Download the Registrations (password=demo): Click
Edit a Registration (password=zdemo): Click
See the Builder Page (password=zzdemo, view only, functionality disabled): Click
View/Download the configuration file used to generate this page

If you fill out and submit this form, you will not be able to complete the payment, but you will receive an email with a PENDING confirmation (provided you use your real email address).

Required fields are in BOLD

First Name:      Last Name:     Gender:  F    M     Student
First Name Last Name Gender Child Child Age Student
M
M
M
Do NOT share personal information
Phone 1:     (format: 123-456-7890)    Home   Cell   Work  
Phone 2:     (format: 123-456-7890)    Home   Cell   Work  
Street  
City  
State  
Zip  
Email  
Number of Men Dancers  
Number of Women Dancers  
Custom Text  
Custom Number  
Custom Option
Notes  (max length = 1000 chars)

Hospitality Request: Number of People  
Hospitality Request: Number of Beds  
Hospitality Request: Smoker
Hospitality Request: Cats OK
Hospitality Request: Dogs OK
Hospitality Request: Notes (Allergies, etc.)  
Hospitality Request: Carpooling With  
Hospitality Offer: Number of People  
Hospitality Offer: Number of Beds  
Hospitality Offer: Smoker
Hospitality Offer: Have Cats
Hospitality Offer: Have Dogs
Housing: Offsite  
Housing: Womens Cabin  
Housing: Mens Cabin  
Housing: Couples Cabin  
Housing: Snorers Cabin  
Housing: Adult in Family Cabin  
Housing: Child in Family Cabin  

Please Select a Color:  Red   Green   Blue  
Please Select a Number:  One   Two   Three  
Please Select Another Color
Please Select Another Number
Musicians Musician Name
Instruments
Bands
In Band Scramble    In Open Band    In Named Band   


Musician Name
Instruments
Bands
In Band Scramble    In Open Band    In Named Band   
Callers Caller Name
Call Contra    Call English   
Call Other


Caller Name
Call Contra    Call English   
Call Other
Attendance and Merchandise
Option Price     Qty
Adult $85
Student Jr High and up $45
Child 12 and under $35
CDSS Member Discount $-5
Early Registration Discount $-10
T-Shirt Small $14
T-Shirt Medium $14
T-Shirt Large $14
T-Shirt Extra Large $14
Membership: Single: $20      Family: $30
Donation (OPTIONAL, but appreciated) $
PayPal Fee (OPTIONAL, but appreciated) $0

Total $0  
Deposit ($150) $0
Payment $0  
Balance Due by Feb 1, 2016 $0  
Payment

Please fill in the form and click the Pay button.
You will be asked to confirm before transferring to PayPal, and you can complete or cancel the transaction in PayPal.
In PayPal you can pay via your PayPal account, or use a credit card.
No PayPal account is needed for credit card payments.
A confirmation email will be sent from both PayPal and from us when payment is completed (NO email if transaction is cancelled).

For online registration problems, please contact the webmaster: gemdancer@fastem.com

Created by GM Online Registration System, version 1.3.4