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2011 Annual Benefit -Registration Form

Are you a BDA member? Click here to login.
Not a member but want to join? Click here.

Fill the Form Below:

First Name* :
Last Name* :
Street Address* :
Address Line 2 :
City* :
State* :
Zip Code* :
E-Mail* :
Phone* :

Number of members attending @ $50:
(Paying Basic and Premium members only)
Number of non-members attending @ $75:
Can't attend? Consider puchasing tickets for a dancer to attend in your place  

Number of Dancers @ $75:
Purchasing more than one ticket? List other attendee names here:

Number of tables for 4 @ $325:

Select payment type :
 
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Boston Dance Alliance | 19 Clarendon St. | Boston, MA 02116-6100 | 617-456-6295