* 2012 Platinum DanceSport Classic *

PRO/AM & STUDENT/STUDENT INTERNATIONAL STYLE ENTRY FORM

Dances for each division are as follows:
A Newcomer Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive B Pre-Bronze Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive C Int Bronze Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive D Full Bronze Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive E Pre-Silver Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive F Int Silver Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive G Full Silver Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive H Pre-Gold Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive J Int Gold Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive K Full Gold Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive L Open Bronze Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive M Open Silver Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive N Open Gold Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive O Gold Star I Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive P Gold Star II Waltz, Tango, V. Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive Q Closed 3-Dance Bronze Championship (A, B or C) * ** Waltz/Tango/Quickstep, Cha-cha/Rumba/Jive R Closed 4-Dance Silver Championship (A, B or C) * ** Waltz/Tango/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Jive S Closed 4-Dance Gold Championship (A, B or C) * ** Waltz/Tango/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Jive T Closed 4-Dance Scholarship (A, B or C) * ** Waltz/Tango/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Jive U - Open Youth 4-Dance Championship (Ages 12-18) * Waltz/Tango/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Jive V Open Senior 3-Dance Championship (Ages 65+) * Waltz/Tango/Foxtrot, Cha-cha/Rumba/Jive W WPDS Open 5-Dance Championship (A, B, or C) * ** *** Waltz/Tango/V Waltz/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Paso Doble/Jive X Open 5-Dance Scholarship (A, B or C) * ** Waltz/Tango/V Waltz/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Paso Doble/Jive

Ages:

Pre-Teen (11 & Under) Junior 2 (14-15) Junior 1 (12-13) Youth (16-18)

A1 (19-35) A2 (36-50)

B1 (51-60) B2 (61-70)

C1 (71-80) C2 (81+)

Other: * ** ***

Dancers must enter an equal number of single dances in order to enter multi-dance events. Ladies and gentlemen will be combined for all multi-dance events. Age categories are as follows: A (19-35) B (36-50) C (51+) World Pro/Am DanceSport Series qualifier. Participation in the WPDS is not necessary to enter.

Professional Studio Professionals Address City

Student

Phone # State
Division Age Gender W T V

NDCA# Email

SS# Zip Code

F Q C S R P J

* Deadline: January 23, 2012 * Please send complete entries (entry form, waiver, accounting form & check or money order payable to Platinum DanceSport Classic) to: Platinum DanceSport Classic, 1914 Haverhill Road, Baltimore, Maryland 21234. Telephone (410) 825-5483. FAX (410) 665-4252. Entries will not be processed without payment in full. Incomplete entries or entries received after January 23, 2012 will be accepted at the discretion of the organizers if space & time permit. Page One

* 2012 Platinum DanceSport Classic *

PRO/AM & STUDENT/STUDENT INTERNATIONAL STYLE ENTRY FORM Professional (or Student/Student Man) Student (or Student/Student Lady)
Single Entries @ $ ($35 Package A-E Holders, $40 Non-Package Holders, $15 Pre-Teen & Junior, $25 Youth) Closed 3-Dance Championships @ $ ($75 Package A-E Holders, $85 Non-Package Holders) Closed 4-Dance Championships @ $ ($85 Package A-E Holders, $95 Non-Package Holders) = $

= =

$ $ $ $ $ $ $ $

Closed 4-Dance Scholarships @ $ = ($95 Package A-E Holders, $105 Non-Package Holders) Senior 3-Dance Championships @ $ ($75 Package A-E Holders, $85 Non-Package Holders) Youth 4-Dance Championships @ $ ($85 Package A-E Holders, $95 Non-Package Holders) = =

Open 5-Dance Championships @ $ = ($95 Package A-E Holders, $105 Non-Package Holders) Open 5-Dance Scholarships @ $ = ($105 Package A-E Holders, $115 Non-Package Holders) TOTAL =

WAIVER
All persons attending the Platinum DanceSport Classic (spectators, competitors, officials, staff, guests, etc.) shall be bound by the rules and regulations of the National Dance Council of America (NDCA) and Platinum DanceSport Classic. The organizers, NDCA and hotel can accept no responsibility for loss or theft of articles left in the changing rooms, ballroom, guest rooms or hotel. Neither can they be held liable for injury sustained by persons attending the Platinum DanceSport Classic. Everyone does so at his or her own risk and expressly and irrevocably waves any claim or claims arising from any loss or injury incurred at this event. In addition, this event may be photographed and recorded by television, video, photography or other method. All persons attending this event, by their presence, may be photographed, videotaped or broadcasted and waive any claim related to the use of their image, their rights of any copyright, privacy or publicity and consent to the use, exhibition, transmission, distribution or sale of such images by Platinum DanceSport Classic, its organizers, employees, vendors and representatives in any type of media throughout the world without limitations. Signature (Guardian, if Minor) Printed Name Date

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