Spring Fling Workshop With Derek Steele Saturday, April 18th, 2015 Backroads Saloon 15325 W. Michigan Ave, Marshall, MI 49068 One day workshop including evening lessons and admission to club that night. Registration 10 am, Lessons 11 am-5 pm. Lunch break from 1:00 - 1:30 with pizza, salad bar and drink $35 for entire workshop including lunch and admission to club that night Derek will be joined by Lia Reau and Pete and Jen Zappulla Name:_____________________________________________________________________ Address:_______________________________________________ State:_______________ Zip:_______________ Phone:____________________________ Email:___________________________________ Dance level: Beginner Intermediate I, the undersigned, for myself, heirs, executors, and administrators, hereby waive, fully release and agree to hold harmless the organizers of the event, employees, staff members and agents from any and all lawsuits, claims or demands arising from and in connection with this event, whether as a spectator, attendee or staff member. I understand the physical risks of social dancing and assume full responsibility for any injury or personal damages resulting from my participation in this event. I hereby authorize the reproduction, sale, copyright, exhibition, broadcast and/or distribution of any videotape and photographs taken of me during the activities associated with the event, without limitations. I certify that I am 18 years or older (applies to Legal Guardian if under 18 years of age). I understand and fully acknowledge that NO REFUNDS will be issued. Signature:_______________________________ Date:______________________ Make Checks Payable to: Backroads Saloon Mail Registrations to: Derek Steele 6099 Lakeshore Rd Burtchville, MI 48059 For additional information contact Derek-586-360-6792. Ddsteele199@comcast.net Hotel info: Arbor Inn Located right next door to Backroads Saloon Room rate-49.99 +tax. Phone (269) 781-7772