event logo

 

 

Mid-Ohio Boogie Bash 2012

Registration Form

Note: If you would like to use PayPal, then this form is not needed. Please use “Get Your Ticket”, and indicate your purchase request at the bottom of the page. Thank-you.

Ticket 1

Name:

                                                                                

Address:

                                                                                

    

                                                                                

    

                                                                                

Phone:

                                                                                

Email:

                                                                                

We will only use your email for items related to Mid-Ohio Boogie Bash

Name:

                                                                                

Your first name as you would like it to appear on your name button

Your club affiliation(s)

    

                                                                                

    

                                                                                

Ticket 2

Name:

                                                                                

Address:

                                                                                

    

                                                                                

    

                                                                                

Phone:

                                                                                

Email:

                                                                                

We will only use your email for items related to Mid-Ohio Boogie Bash

Name:

                                                                                

Your first name as you would like it to appear on your name button

Your club affiliation(s)

    

                                                                                

    

                                                                                

Early-Bird Special Prices

after July 16th, 2012

Weekend Passes are $87.50 and Day Passes are $72.50)

 

Ticket Type

Number of Tickets Requested
Weekend Pass        $87.50 each $                    
Friday – Day Pass        $72.50 each $                    
Saturday Day Pass        $72.50 each $                    

Total

 $                    

Mail the filled out registration form, your check made out to “Mid-Ohio Boogie Bash”, and a self-addressed stamped business-size envelope to:

Mid-Ohio Boogie Bash
7714 Morse Road
New Albany, OH 43054-9513

Mark your calendar for August 16th through 19th, 2012

This is one dance weekend you don’t want to miss!