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     Child     Child Age: 
First Name Last Name Gender Child Child Age Student
M
M
M
Do NOT share personal information
Phone 1:     (format: 123-456-7890)    Cell   Home  
Phone 2:     (format: 123-456-7890)    Cell   Home  

Street  
City  
State  
Zip  
Email  
Number of Men Dancers  
Number of Women Dancers  
Custom Text  
Custom Number  
Custom Decimal  
Custom Option
Notes  (max length = 1000 chars)

Please Select a Color:  Red   Green   Blue  
Please Select a Number:  One   Two   Three  
Please Select Another Color
Please Select Another Number
Hospitality
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
Housing: Offsite  
Housing: Womens Cabin  
Housing: Mens Cabin  
Housing: Couples Cabin  
Housing: Snorers Cabin  
Housing: Adult in Family Cabin  
Housing: Child in Family Cabin  
Musicians
Musician First Name  
Instruments  
Bands  
In Band Scramble    In Open Band    In Named Band

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

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

Total $0  
Deposit ($150) $0
Payment $0  
Balance Due by June 1, 2222 $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 1.9