WASCA 45th Spring Square and Round Dance Festival

WEARIN' O' THE GREEN

March 18, 19, 20,  2004

Housing Registration

Name:  ________________________________________________________________________________

Address:  _______________________________________________________________________________

City, State, Zip: __________________________________________________________________________

Number of People: ______ Phone:  (______)__________________ Email: ______________________________

Deposit Required:  $99 - Penalty charge for early checkout

Single/Double = $99     Triple/Quad = $109      1 Bedroom Suite = $209      2 Bedroom Suite = $308

Room Requirement:    [   ]  Double    [   ]  King      [   ]  Parlor with _____ bedrooms      [   ]  Smoking Room      [   ]  Non-Smoking Room

Please reserve room for:   [   ]  Wed. March 17    [   ]  Thurs. March 18      [   ]  Fri. March 19     [  ]  Sat. March 20

[   ]  Check      [   ]  Visa       [   ]  MasterCard      [   ]  American Express      [   ]  Diners      [   ]  Discover

Credit Card Number _____________________________________Expiration Date: ____________________

Signature:  _____________________________________________________

Please make checks and money orders payable to the Hyatt Regency.

Mail to:   Jay Kolakoski                8307 Southstream Run                Springfield, VA 22153

Phone: 703-455-3009                            Email: jkolakos@juno.com