WORLD CAMP, OCTOBER 14 - OCTOBER 17, 2011 / Iroquois Springs, Rock Hill, NY -USA

REGISTRATION FORM - Print, fill out and mail to address below

Name(s):______________________________________________________

Address:______________________________________________________

City, State, Zip:_________________________________________________

Country:_______________________________________________________

Phone:________________________________________________________

Email:_________________________________________________________

Accomodations - check one:

Woman cabin:_____________   Man Cabin:___________   Coed cabin:______________

If you wish to be roomed with someone, list all names.

________________________________________________________________________________________________

________________________________________________________________________________________________

ALL persons must indicate preferences here:

Food Preference

No Restrictions:_______ Vegetarian:_______ Other (please explain):__________________________________________

Registration Fees Enclosed (please complete):

Adult-Entire Weekend    ----------------------------------------------#_____persons @ US $390.00 each_______

Youth (ages 8 through 18)---------------------------------------------#_____persons @ US $250.00 each_______

Two full days & nights (saturday + Sunday) ----------------------#_____persons @ US $290.00 each_______

One full day including the same night party------------------------#_____persons @ US$ 160.00 each_______

One night party-----------------------------------------------------------#_____persons @ US$ 30.00 each_______

Late Fee (after October 1st. )------------------------------------------#_____persons @ US$  20.00 each_______

TOTAL ENCLOSED -------------------------------------------------------------------------------------------$_________

Waiver of Responsibility World Music and Dance Camp does not cover bodily injury to any person participating
in dance or other activities which we sponsor or which are conducted on premises we rent or use. Your registration
signifies acceptance of the above statement and that you personally assume responsibility for any medical costs incurred.

Please mail this form with payment in US. funds to:

World Camp c/o Ahmet Luleci
16 Braeland Ave.
Newton Centre, MA 02459 - 2211

For more info, http://www.worldcamp.us or email us at: info@worldcamp.us