Print this page 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 Tom Spittler and Kathy Woeltjen at 707-829-0168.

Name(s) for nametag(s) ______________________________________________________

Address __________________________________________________________________

City ___________________________________ State ___________ Zip ________________

Telephone _____________________________ Email ______________________________






Early registration, postmarked by May 17


  _____ _____

Registration after May 17 (if not sold out)


  _____ _____

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.

I will bring something ____ sweet ____ savory to share at the break.

To register, mail this form and your check to:

Mad Robin Ball
c/o Kathy Woeltjen
185 Dutton Ave.
Sebastopol, CA 95472

Last modified 2/24/04 by MRB webmaster