KICKIN INTO SUMMER - Lone Star Steppers

MINEOLA LEAGUE OF THE ARTS
KICKIN‘ INTO SUMMER
Friday May 15, 2015 from 10am to 3pm
$25 (includes
lunch)
rd
Registration after April 3 is an additional $5.00
Registration—Please Print Information
Name: (First)________________________________ (Last)___________________________________
Address___________________________ City _____________Zip_______Phone_________________
Email:_____________________________________ Instructor:_______________________________
City Where You Dance_______________________ Emergency Contact__________________________
Emergency Phone Number:_____________________ If I require emergency medical care, I authorize
transport to the nearest hospital? YES or NO (circle choice)
Mail Payment to 200 W Blair Mineola TX 75773
Make check payable to Mineola League Of The Arts Early registration $25.00 _____________
Non Refundable
After April 3rd
$30.00 _____________
Pre Kickin’ open floor dance from 6pm to 8pm May 14, 2015 ___________
$5.00 ______________
at the Mineola League Of The Arts 200 W Blair
PreMineola
Kickin, $5.00
$_________
Total
$_________
Any questions please call 903-253-6695 or email barbara0130
@suddenlink.net
TOTAL _____________
Waiver Statement
I, the undersigned, release, hold harmless and discharge the Mineola League Of The Arts (MLOTA), and all teachers, helpers and
coordinators of Kickin’ Into Summer from any liability, claim, loss, damage, cost or expense. I waive any such claims against these
organizations or such person in connection with the execution of the event. I understand the physical risk of entering line dance and social
dance events and assume full responsibility for any and all injury or personal damages resulting from the event named above. I authorize
any and all still pictures and videos of this event that includes attendees.
________________________________________
Signature of Participant
________________________________________
Printed Name
Please register before April 24, 2015
……………………………………………………………………………………………………
Keep This Portion For Your Information
Kickin’ Into Summer, Friday, May 15, 2015 10am to 3pm
Directions to AMERICAN LEGION HALL: 2015 U.S. Hwy 80. From Hwy 69 and Hwy 80 (downtown Mineola) go
east on Hwy 80 for 3 miles. The American Legion Hall will be on your left. To see a printable map go to
http://lonestarsteppers.com/files/American Legion Hall.pdf
MLOTA is a non-profit organization.
www.mlota.org
903-569-8877
Lone Star Steppers web page http://lonestarsteppers.com/