Florida Folk Dance Council, Inc. (FFDC) Proudly Presents:
                      Florida Folk Dance Camp with Jim Gold and Lee Otterholt
                                    February 20-23, 2004 in Silver Springs, Florida 

           REGISTRATION FORM    (ONE per person please - make duplicates if needed)

Last Name _________________________________  First Name ___________________________

Full Address _____________________________________________________________________

Email _______________________________________ Phone ______________________________
	Do you want to receive your monthly newsletter by email?  (Circle)    Yes	No
		                                    CAMP FEES:
Full Time  (Mark on Left Lines to indicate your choice - Fill in amount of money on Right)	
	____ ON Campus  (Three nights, nine meals)		$200.00	___________
	____ OFF Campus (Three nights, nine meals)		$150.00	___________
Part Time  
	____  ON Campus  (Two nights, six meals)			$140.00	___________
	____  ON Campus  (One night, five meals)			$110.00	___________
	____  ON Campus  (One night, three meals)			$ 70.00	___________
	____ OFF Campus  (Two nights, six meals)			$110.00	___________
	____ OFF Campus  (One night, five meals)			$ 95.00	___________
	____ OFF Campus  (One night, three meals)		$ 55.00	___________
Rv’s - Off Campus fees as applicable plus a $20.00 fee per vehicle / Tents - Off Campus fee	___________
(Meals are included in the cost of a stay for one day, night, etc. on or off campus, whether
 one partakes of them or not.  Checking of meals listed below is for kitchen preparation)
Camp Video     .................................................................................  $15.00	___________
Camp T-Shirt  (T-shirt design in FFDC Newsletter or at www.folkdance.org)    $10.00	___________
(Circle size & color to order)   S    M    L   XL     Bright Pink     Bright Yellow       Charcoal
Contributions to Olga Princi Scholarship are appreciated but not required		___________
									 Sub Total	___________
If registration for full time is postmarked by January 15th ......... $ 5.00  Minus   ___________
If full time & 2004 dues are paid by Jan. 15th (or accompany this form - separate
check for membership: $15.00 single/$20.00 family (2 adults at same address)       $10.00  Minus   ___________ 
(Night Party Walk-ins: $10.00 (Students $5) / Student discount of $10 per day              Total	____________

Circle the following nights you will be sleeping at Camp:   Friday     Saturday     Sunday
Expect to share cabin with other dancers (8 maximum but “lots” of  bath. space / 2 Couples to a Cabin sharing bath
Circle the following meals in attendance (B-Break./L-Lunch/D-Dinner) First meal, “D” on Fri./Last, “ L” on Mon.
      Fri. D     Sat. B     Sat. L     Sat. D     Sun. B     Sun. L     Sun. D     Mon. B     Mon. L 
Special Diet Preference:   Vegetarian     Lactose Intolerant     Other ________________________

Please Note:  Remember that dancing, like any physical activity, can carry the risk of injury.  Dancing is on a concrete
floor covered with linoleum tiles.  Camp environment is rural with limited lighting.  Neither FFDC, Inc., nor its members,
officers or directors have resources to cover costs of any illness or injuries.  Your attendance is important to us, but is
also your representation that you have adequate insurance to cover any possible lost wages, medical expenses and/or
pain & suffering without recourse to FFDC, Inc. or its officers and/or members.

Make all checks payable to FFDC and send to:  J.P. Miller		         Questions:  Ann Kessler       
		2006 Oak Street,  Melbourne, Fl. 32901	                         Annie8@aol.com - or - (727) 789-6480