Moondance Registration Form

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Moondance Registration Form

(NOTE: CONFIRMATIONS & DIRECTIONS WILL BE SENT OUT VIA EMAIL & SNAIL-MAIL, BUT NOT BEFORE APRIL 1! YOUR PAYPAL RECEIPT IS YOUR RECEIPT OF PAYMENT!)

Gate Payments: All payments at the gate MUST BE CASH OR MONEY ORDER, and will be the full price of $60, regardless of when you register, or how long you plan to stay! NO CHECKS AT THE GATE!

You may fill out or send one form for your entire family, all related, living at one address, but please fill out separate forms for roommates or friends.

* = Required Fields

*Legal Name (& Nickname) (1):
*E-Mail Address (1):

Legal Name (& Nickname) (2):
E-Mail Address (2):

*Address:
*City: *State: *Zip:

Home Phone:
Cell Phone:

MINORS:

If you are bringing YOUR children with you who are under the age of 18, list their names and ages here. If YOU are the parent or legal guardian, there is no need to fill out a separate registration form for your children; but by listing their names here you are assuming responsibility for them while they are at the festival under the strictures of the waiver on the back of this page.

Full Name/Age:
Full Name/Age:
Full Name/Age:
Full Name/Age:

If you are bringing children with you who are under the age of 18, and you are NOT the parent or legal guardian, please: a) list their names and ages below; b) have the parent or legal guardian fill out a Minor's Registration Form & Waiver for each child.

Full Name/Age:
Full Name/Age:
Full Name/Age:
Full Name/Age:

Any allergies or medical problems we should know about? (Please tell us *who* these conditions apply to!)

Are you vending? Please read, print, and fill out the Vendor Information Form and send it in with your registration form and payment. NOTE: Vendors do not qualify for discounted admission, but you also do not have to volunteer for a job when you arrive. Deadline for vendors is APRIL 27 - NO EXCEPTIONS!!!

Do you want to hold a class or a ritual? Please fill out the Class and Ritual Volunteer Form and send it in with your registration form and payment. NOTE: Leading a class or ritual counts as part of your community service to the festival, and does not grant you discounted admission (sorry!). Deadline for classes and rituals is APRIL 27 - NO EXCEPTIONS!!!

GENERAL WAIVER AND INFORMED CONSENT TO PARTICIPATE

*(1) I (Legal Name),
and (2) I (Legal Name),
having read and understood the rules and standards of conduct expected while at Cherokee Farms, freely consent to these. Being a voluntary participant at Moondance 2012, at Cherokee Farms, LaFayette, Georgia, May 10-13, 2012, I agree to abide by the above rules and regulations. I also understand that if I do not abide by these, I may be escorted from the site without refund. I also agree to hold harmless the owners of the site of Cherokee Farms, the organizers and staff of Moondance, and all its representatives, from all claims, actions, expenses and demands in respect to injury, loss or damage to my person or property, however caused, arising in connection with my participation even if the same may have been contributed to or occasioned by the negligence of the owners, the said body, or of any of its representatives.

Please type your full legal name below; this will be your electronic signature)

*(1) Signature (parent sign for minor under 18 years of age)
*Date signed:

(2) Signature (parent sign for minor under 18 years of age)
Date signed:

Method of Payment:
I will be paying via PayPal momentarily
I will be mailing a check or money order (paying whatever the current price is when I mail my check)
I will be paying at the gate, full weekend ($60 cash)
I will be paying at the gate, daytrip Friday ($25 cash)
I will be paying at the gate, daytrip Saturday ($25 cash)
I am applying for a volunteer job, and will pay either current price or discounted price once a decision is made on my application. Volunteer Application Form.

PLEASE PRINT A COPY OF THIS PAGE FOR YOUR RECORDS, *BEFORE* CLICKING THE SUBMIT BUTTON BELOW!!

When you click the button below, you will automatically be directed to the PayPal Payment Page. NOTE: If you just want to mail a check or money order, or pay at the gate, go ahead and click the button, but then simply ignore the PayPal page, and hit your Back button to come back to this page; if you want, you can print this page and mail with your payment to the address below (a good idea if you're paying for multiple things). Your registration information that you filled in above will be sent to me automatically.

If mailing this form with a check, please note below what you are paying for.
(NOTE: Current price only good if payment accompanies registration.) Prices per person:
Postmarked and paid by February 1, 2012
$30.00
$________
Postmarked and paid by March 15, 2012
$40.00
$________
Postmarked and paid by April 27, 2012
$50.00
$________
Thereafter
$60.00
$________
Children 12 and under
Free
$________
CST members get $5 off above prices (please email me for a CST payment link)
Daytrip, Friday or Saturday, no overnight camping
$25.00
$________
Daytrip, Child, Friday or Saturday, no overnight camping
$12.50
$________
Pet Fee
$35.00
$________
Vendor Fee up to 250 sq ft space (did you send your Vendor Info Form?)
$10.00
$________
Vendor Fee up to 500 sq ft space (did you send your Vendor Info Form?)
$20.00
$________
Vendor Fee up to 1000 sq ft space (did you send your Vendor Info Form?)
$30.00
$________
Vendor Fee up to 1500 sq ft space (did you send your Vendor Info Form?)
$40.00
$________
Vendor Fee larger than 1500 sq ft space
$50.00
$________
Electricity for Vendors
$20.00
$________
Total enclosed: $________

MAKE CHECKS OUT TO LINDA KERR; mail form and check to:

Linda Kerr
425 Webster Rd. #710
Auburn, AL 36830