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/
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