Reservation Form

Name(s): ________________________________________________________________

Address: ________________________________________________________________ 

Phone: _____________________   e-mail address: __________________________

Dance Instructions? ____

Hospitality:  Yes ___   No ___   Allergies? ____________________

Hotel/Motel Information? _______  Others in Party? ______________________

Food preference for ball dinner: Chicken ___  Vegetarian ___ (Buffet Style)

Cost: Ball/Dinner - RSCDS member($35/$40)* ________  

      Ball/Dinner - non RSCDS member($39/$44)* ________  

      Dinner(nondancer - includes three dances) ($20/$25)* ________

      Dance only ($20) _______

      Saturday Luncheon ($9.50) ______ 
         Cornucopia Sandwich Bar, with Salad and Beverage

Total amount remitted __________

Will you be attending the music workshop? _____ 
Music workshop co-sponsored by Ames Council on the Arts. We have funding
so this event is free!

*ISU requires us to have a guest count by May 1. Therefore, we must
 charge the higher amount for any registration after that date. Please
 include self-addressed stamped envelope for return confirmation.

Please make out check to "RSCDS Central Iowa Branch" and return to 
 
  Gayle Hoepner, Treasurer
  413 10th Street
  Ames, Iowa  50010