* 2012 Platinum DanceSport Classic *

GENERAL ACCOUNTING FORM

(One Person per Form) Name Address City Phone #
Description

Studio State Fax Email

Price Per Person (Regular Rate) * N/A $1,215 (Single) $840 (Double) $740 (Single) $490 (Double) $765 (Single) $515 (Double) $435 (Single) $310 (Double) $455 (Single) $330 (Double) $160 $20 $10 $30 $20 $60 $20 $10 $40 $20 $70 $15 Price Per Person (Early Bird Rate) * N/A $1,160 (Single) $785 (Double) $710 (Single) $460 (Double) $730 (Single) $480 (Double) $415 (Single) $290 (Double) $435 (Single) $310 (Double) $150 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Number N/A Subtotal

Zip Code

Entry Fees (from Entry Forms) Package A (Single or Double) ** Roommate: Package B (Single or Double) ** Roommate: Package C (Single or Double) ** Roommate: Package D (Single or Double) ** Roommate: Package E (Single or Double) ** Roommate: Package F Friday Matinee Adult Admission *** Friday Matinee Child (<16) Admission *** Friday Evening Adult Admission *** Friday Evening Child (<16) Admission *** Friday Buffet Dinner Saturday Matinee Adult Admission *** Saturday Matinee Child (<16) Admission *** Saturday Evening Adult Admission *** Saturday Evening Child (<16) Admission *** Saturday Buffet Dinner Souvenir Program

TOTAL
* ** *** Reservations received and paid for BEFORE JANUARY 23, 2012 qualify for the Early Bird Special (EBS) Additional room nights may be reserved directly through the Mariott Biscayne Bay by calling (305) 374-3900. Use the group name Platinum DanceSport Classic to receive the special group rate of $209 plus tax/night. General Admission
* Deadline: January 23, 2012 * Please send completed entry forms, waivers, 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. No personal checks will be accepted after January 23, 2012. Please see Rules & Regulations for cancellation and refund policies.