* 2012 Platinum DanceSport Classic

*
AMATEUR INTERNATIONAL STYLE ENTRY FORM
Dances for each division are as follows:
A – Newcomer Waltz, Tango, V Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive B – Pre-Bronze Waltz, Tango, V Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive C – Bronze Waltz, Tango, V Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive D – Silver Waltz, Tango, V Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive E – Gold Waltz, Tango, V Waltz, Foxtrot, Quickstep, Cha-cha, Samba, Rumba, Paso Doble, Jive F – Novice (3-Dance) Waltz/Foxtrot/Quickstep, Cha-cha/Samba/Rumba G – Pre-Champ (4-Dance) Waltz/Tango/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Jive H –Open 5-Dance Championship Waltz/Tango/V Waltz/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Paso Doble/Jive J – Open 5-Dance Scholarship (Junior, Youth, Adult) * Waltz/Tango/V Waltz/Foxtrot/Quickstep, Cha-cha/Samba/Rumba/Paso Doble/Jive

Ages:

Pre-Teen 1 Pre-Teen 2 Junior 1

9 & Under 10-11 years 12-13 years

Junior 2 Youth Adult

14-15 years 16-18 years 19-34 years

Senior 1 Senior 2 Senior 3

35-44 years 45-54 years 55+ years

Fees:

$25/Adult or Senior Couple per 1-Dance Event $65/Adult or Senior Couple per 3-Dance Event $85/Adult or Senior Couple per 4-Dance Event $105/Adult or Senior Couple per 5-Dance Event

$15/Pre-Teen, Junior or Youth Couple per 1-Dance Event $40/Pre-Teen, Junior or Youth Couple per 3-Dance Event $50/Pre-Teen, Junior or Youth Couple per 4-Dance Event $65/Pre-Teen, Junior or Youth Couple per 5-Dance Event

Other: Couples may dance in 2 age divisions & 2 levels per dance style. Entry fees include admission to the ballroom for entered events. Pre-Teens are restricted to syllabus events. * Couples must dance in at least one 4- or 5-dance event in the same style to enter the Scholarships.

Man Address City Studio Man Sample – John Doe Phone #

Lady

State

Zip Code Email Dances W, T, V, F, Q

(Only one entry per line please) Lady Age Division Style Jane Doe Adult C Standard

Single Entries @ $ = $ ($25 Adult/Senior Couple, $15 Pre-Teen/Junior/Youth Couple) 3-Dance Events @ $ = $ ($65 Adult/Senior Couple, $40 Pre-Teen/Junior/Youth Couple) 4-Dance Events @ $ = $ ($85 Adult/Senior Couple, $50 Pre-Teen/Junior/Youth Couple) 5-Dance Events @ $ = $ ($105 Adult/Senior Couple, $65 Pre-Teen/Junior/Youth Couple) TOTAL = $

Page One

* 2012 Platinum DanceSport Classic *
Waiver
All persons attending the Platinum DanceSport Classic (spectators, competitors, officials, staff, guests, etc.) shall be bound by the rules and regulations of the National Dance Council of America (NDCA) and Platinum DanceSport Classic. The organizers, NDCA and hotel can accept no responsibility for loss or theft of articles left in the changing rooms, ballroom, guest rooms or hotel. Neither can they be held liable for injury sustained by persons attending the Platinum DanceSport Classic. Everyone does so at his or her own risk and expressly and irrevocably waves any claim or claims arising from any loss or injury incurred at this event. In addition, this event may be photographed and recorded by television, video, photography or other method. All persons attending this event, by their presence, may be photographed, videotaped or broadcasted and waive any claim related to the use of their image, their rights of any copyright, privacy or publicity and consent to the use, exhibition, transmission, distribution or sale of such images by Platinum DanceSport Classic, its organizers, employees, vendors and representatives in any type of media throughout the world without limitations. Signature (Guardian, if Minor) Printed Name Date

* Deadline: January 23, 2012 * Please send complete entry (entry form, waiver & 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.
Page Two