Print this page (or download the whole flier) and mail it with your check to the address at the bottom. A copy of the ball booklet with instructions for all dances will be mailed to registered dancers beginning in April. For more information, e-mail or call Gayle Bergmann.

Name(s) for nametag(s) ______________________________________________________

Address __________________________________________________________________

City ___________________________________ State ___________ Zip ________________

Telephone _____________________________ Email ______________________________

  Number Total
Early registration, postmarked by May 12
  _____ _____
Registration after May 12 (if space available)
  _____ _____
Gallery (non-dancer)
  _____ _____
Dancing child under 12
  _____ _____
Additional donation
I am enclosing

Make check payable to Mad Robin Ball.

I'd like to volunteer to help ____ beforehand ____ that afternoon ____ at the ball

To register, mail this form and your check to:

Gayle Bergmann
3639 Frei Rd.
Sebastopol, CA 95472

Last modified 3/26/02 by MRB webmaster