RSCDS
YORK & NORTH HUMBERSIDE BRANCH
DAY SCHOOL 3rd OCTOBER 2009
APPLICATION FORM
Surname: (Mr/Mrs/Miss/Ms/Dr)........................................................................
First Name: (for name tag)................................................................................
Address: .........................................................................................................
......................................................................................................................
......................................................................................................................
Post Code: .......................... Tel: ...................................
CLASS |
£7.00 | No........ | £..................... |
HIGH TEA |
£4.00 | No........ | £..................... |
* Please make a note if you have any special dietary requirements. |
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DANCE if attending class |
£7.00 | No........ | £..................... |
DANCE only |
£8.00 | No........ | £..................... |
I enclose cheque/cash for: |
Total | £..................... | |
payable to RSCDS York & North Humberside Branch |
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Signed...............................................................
Date............................................
Please send application with s.a.e. to:
G. Edwards
137 Carr Lane
Willerby
Hull
East Yorkshire
HU10 6JT
tel: 01482 657130
Alternative (emergency contact)
Malcolm Brown 01904 488084