PLEASE PRINT
Last Name:_____________________________ First:_________________________ Address:_____________________________________________________________ City:_____________________________________ State:______ Zip:____________ Country:_____________________________________________________________ Phone:_______________________________ Cell:___________________________ Email:_______________________________________________________________
Registations are non-transferable. Registration fee per Registrant. Adult $60.00, Youth born after June 25, 1996 $30.00. 5 and under June 25, 2014, Free admission. A $10.00 fee per Registrant will be imposed for cancellations or changes. Prices will increase May 1, 2014 to: $75 for adults, $37.50 for Youth born after June 25, 1996. After April 30, 2014 e-mail confirmation only. Number of past Conventions Attended
Appt#: _____________________________________________________________ Batch#: _____________________________________________________________ Date: ____________________________________________
63RD National Square Dance Convention® “Rock-N-Little Rock in 2014” GSI Registration Form June 25, 26, 27, 28, 2014 Little Rock, AR Website: www.63nsdc.com Directions for completion of Registration Form on back
❑ Solo
First Name - for badges - Last Name
____Adult:___________________ ____Adult:___________________ ____Adult/Youth:______________ ____Adult/Youth:______________
_______________________ _______________________ ___________DOB________ ___________DOB________
Subtotals
____.00 ____.00 ____.00 ____.00
Program Book w/daily schedules ($15.00 after 4/30/2014) ................... ______@$10.00 ____.00 Syllabus: ❑ Rounds ❑ Clogging ❑ Contra ................................. Total# ______@$ 9.00 ____.00 On CD: ❑ Rounds ❑ Clogging ❑ Contra.......................... Total CDs# ______@$ 9.00 ____.00 Syllabus and CD ..................................................................................... ______@$15.00 ____.00 Sew ‘n Save the Natural Way - CD and Book ........................ Total# ______@$15.00 ____.00 Book ......................................................................................... ______@$ 9.00 ____.00 CD............................................................................................. ______@$ 9.00 ____.00 Cookbook - “Diamond Recipes” ................................................. Total# ______@$12.00 ____.00 Wednesday Special Event - Ronnie McDowell ..................................... ______@$20.00 ____.00 Wednesday Special Event w/Dinner ..................................................... ______@$40.00 ____.00 ❑ Hotel Bus Pass ❑ RV Park Bus Passes - 4 day pass (See Reverse).. ______@$50.00 ____.00 ($60.00 after 4/30/2014) RV Full Hookups Electric 30 or 50 amp, water, sewer (4 night minimun).....______@$40.00 ____.00 RV Electric 30 0r 50 amp/water (4 night minimum).............................______@$35.00 ____.00 ____.00 Tours - Please see reverse for payment information and instructions. Leadership Certification Program ................(No Charge) Please E-Mail Information Yes ❑ No ❑ No Refunds/Cancellations after April 30, 2014.....................................Total(U.S. Funds) ____.00 We will pre-register all campers. You will recieve a profile form. To camp together, arrive together.
Sa Su M Tu W Th F Sa Su 21 22 23 24 25 26 27 28 29
Credit Card #: _____________ _____________ ____________ ____________ ❑ Check (enclosed) Expiration Date: _______________/_______________ ❑ Visa ❑ MasterCard ❑ Discover Card Security Code _____________________ Signature: _______________________________________________________________________ Mailing Address w/zip code of Credit Card Statement: ____________________________________ _______________________________________________________________________________ Registration Office Fax: 501-345-3225 Office Phone: 870-834-5362 E-mail: registration@63nsdc.com
For Convention Use Only Registration # _________ Date Received ________ Check # _____________
Complete the housing portion of this form only if you choose not to make your Hotel Reservation online at www.63nsdc.com Requests for Shared Rooms or Same Hotel can be made through the online site or registrations can be mailed and arrive together in the same envelope.
Housing Required? ❑ YES ❑ NO Please Check Room Nights Needed:
June
21
Sat
22
Sun
23
Mon
24
Tues
25
Wed
26
Thurs
27
Fri
28
Sat
29
Sun
Hotel Preference (hotel codes on back): 1st ______ 2nd______ 3rd_____ 4th_____ Please check the appropriate box: ❑ One Bed (1-2 people) ❑ 2 Beds (2-4 people) Preference: ❑ Non-Smoking ❑ Smoking ❑ Wheelchair Accessible Room Special Hotel Room Needs: _______________________________________________ Additional Room Occupants: ______________________________________________ Same Hotel as: _________________________________________________________ For Assignment in Block Housing - Requests are due by January 2, 2014. ❑ Block Housing - 10 or more rooms. Block Leader Name: ______________________________ Phone:_____-_____-_____ Email: ________________________________________________________________ Your Hotel Reservations must be guaranteed with a credit card
Print Name On Card: _______________________________ ❑Visa ❑ Master Card Credit Card #: _________ _________ _________ ________ ❑ Discover Card Expirations Date: ____________/___________ Security Code ______________ Return Form, with payment, to: 63rd National Square Dance Convention® Registration & Housing Committee PO Box 4052, Batesville, AR 72503 Form may also be sent by fax, with credit card information to: 501-345-3225
Adults will dance: (Check all that apply) Squares: ❑ M ❑ P ❑ A1 ❑ A2 ❑ C Rounds: ❑ 2 ❑ 3/4 ❑ 5/6 Other: ❑ Clogging ❑ Contra ❑ Line Dancing/Country Western ❑ Handicapable Program info for Callers/Cuers/Education ( your expertise) Name: Caller:______ Cuer:______ ❑ Caller & Level ( ❑ M ❑ P ❑ A ❑ C) ❑ Cuer & Level ( ❑ 2 ❑ 3/4 ❑ 5/6) ❑ Caller for Youth ❑ Clogging Instructor ❑ Contra Prompter ❑ Exibition Group ❑ Educator ❑ Handicapable ❑ C/W Lines Instructor ***Go to www.nsdcnec.com to update your profile***
63rd Convention Badges REQUIRED at all times. Dressy Casual attire is permitted during the day. Proper Square Dance attire is required after 6:00 PM
Rev. 06/17/13
1. Arkansas Baptist College; 1621 Dr. Martin Luther King Dr. 2. Arkansas State Capitol 3. Central High School National Historic Site & Museum; 2125 Daisy Bates Drive 4. River Market District
Midtown Little RockInstructions for registration (left side) 1. Print legibly all names, address, city, state, zip code, country and youth DOB (after June 25, 1996 ½
Crowne Plaza
Double Tree by Hilton
Hilton
Wyndham Riverfront
Little Rock Marriott
5. Arkansas State Fairgrounds & Barton Coliseum;
tD ron erf Riv
price)1900 to ensure correct Roosevelt Road registration. 2.Correctly enter Bridge; all amounts in the subtotals including registration fee for each dancer plus quantity and 6. Big Dam 7600 Rebsamen Park Road amounts all other and tours. 7. Littlefor Rock Zoo; materials 1 Jonesboro Drive 3.Important! Dailyofschedules only available with the purchase of a program book. Daily schedules will 8. University Arkansas are at Little Rock; 2801 S. University not9.be available separately at1the convention. Most dancers will want to purchase the program book. War Memorial Stadium; Stadium Drive (Markham) 4.Correctly calculate theWater total and include creditSprings card information (with signature), check or money order 10. Willow Springs Park; 3903 Willow Rd. payableLittle in U.S.Rock funds to the 63rd National Square Dance Convention® and return it with the registration West form. Do not send cash. No single day Pinnacle registrations sold. 11. Pinnacle Mountain State Park; 11901 Valley Rd., Roland 5.RV12. Camping: on your WildwoodIndicate Park forRV theCamping Performing Arts;registration 20919 Dennyform Rd. and enclose the required fees (four night minimum) cover the nights that 12120 you intend toGlenn stay. Rd. Please check appropriate boxes. RV camp sites 13. Little to Rock Climbing Center; Colonel will be assigned Airport Area on a first come, first served basis. There is a 30 and 50 amp service at the RV sites. Full Water, Sewer and Electric 14.Hookups, Little Rock National Airport; Airport (50 Driveamp). Electric/Water Only (30 & 50 amp) Dump Station on site. Honey Wagon available for additional fee. If you plan to camp together, you must arrive North Little Rock together. ForArena; more information, contact 15.Verizon One Verizon Arena WayE-mail-registration@63nsdc.com. 6.Hotel Bus PassNational and RVGuard Park Bus Passes areRobinson available only to registered dancers staying in Hotels and 16. Arkansas Museum; Camp RV in ourQueen; blocks.100 Riverfront Drive 17.Parks Arkansas 18. forms Dickey-Stephens Park; 400 7.Tour and Payments areW. to Broadway be mailedSt.directly to: 63rd National Square Dance Convention, PO 19.The Old Mill; Lakeshore at Fairway Box 4052, Batesville, AR 72503. For tour information and form go to www.63nsdc.com and click tours. 20. Arkansas Inland Maritime Museum home to the USS Razorback; Include completed tour form with this registration form. Little Rock Tours is responsible for all tours, not 100NSDC. RiverfrontTours Driveare taken at your own risk. the 63rd
e riv
Bill and Hillary Clinton National Airport
MLK
Historic Curran Hall
21. Wild River Country; 6820 Crystal Hill Road
Jacksonville
To P i
ne B
22. Little Rock Air Force Base
Hospitals
Instructions for Housing (right side)
1.The NSDCChildren's Housing Committee is partnering 23.63rd Arkansas Hospital; 1 Children’s Way with the Little Rock Convention and Visitors Bureau (LRCVB) housing bureau to provide access 24. Arkansas Heart Hospital; 1701 S.website Shackleford Road for housing reservations. Once registered, dancers can reservations on line at www.63nsdc.com 25.make Baptist Health Medical Center; 9601 I-630, Exit 7or by sending in the printed registration form to the 63rd Registration and Housing Committee, the same way dancers have made housing registrations for 26. Baptist Health Medical Center; 3333 Springhill Dr., North Little Rock LaQuinta past 27. conventions. CARTI; Baptist; 9500 Kanis Road Downtown 2.Complete the St. housing of this form only if you choose not to make your hotel reservation online at 28. CARTI; Vincent;portion 5801 West Markham www.63nsdc.com. ThisMemorial form mustVeterans be received by May 2014 to receive the 63rd NSDC contracted Hotel 29. John L. McClellan Hospital; 430015, West Seventh Hotel Name Code room rates. 30. Southwest Regional Medical Center; 11401 I-30 3.Only person Doctors per roomHospital; should complete a hotel reservation request. Please list all room occupants. 31.one St.Vincent 6101 St.Vincent Circle 1 **Little Rock Marriott (The housing committee not find or assign roommates.) 32. St. Vincent Infirmarydoes Medical Center; (formerly Peabody) 4.Shared Rooms or Circle SameatHotel Requests can be made through the online site or mailed together in the Two St.Vincent Markham Headquarters Hotel same envelope of to Arkansas arrive together. 33. University for Medical Sciences; 5.All block housing application requests staying in the same hotel are due by January 2, 2014 submitted 2 **Double Tree by Hilton 4301 West Markham with name and Courses telephone number of leader. Public Golf Caller/Cuer Hotel 6.Indicate fourPark; (4) choices housing preference, by specifying hotel code number. Be sure to indicate 1 34. Burns I-40, Exitof150 Hotel / Bus Pass needed or35. 2 beds as well as 60 preferences. Hotels will be assigned on a first come, first served basis according to Hindman Park; Brookview Dr. availability. 36. Rebsamen Park; 3400 Rebsamen Park Dr. 3 Wyndham Riverfront s 37.The First Tee;Your #1 First Tee Way 7.Hotel reservation: reservations must be guaranteed with a credit card. Your credit card will ring pnot Vendor Hotel S t o War Memorial Park; W. and Markham be38. charged in advance of 5110 arrival an alternate form of payment may be presented at check To Hin. 4 LaQuinta Downtown 39. confirmations: Stone Links; 110 Hwy 391 North a hotel confirmation via email or mail once the Hotel you have 8.Hotel You will receive selected can begin making reservations. See note below.. If you do not receive your confirmation 5 Holiday Inn Presidential within 21 days, please contact the 63rd NSDC Registration & Housing Committee by: (a) email: 6 Comfort Inn & Suites registration@63nsdc.com, (b) fax at 501-345-3225; (c) 63rd NSDC, attn.:Registration & Housing Committee, PO Box 4052, Batesville, AR 72503 through May 15, 2014. 7 Clarion Hotel 9. Please read before making your Hotel selections Hotels 2,5,8,9 cannot make reservations and Medical Center provide you with confirmation until 50 weeks prior to arrival date, which is on or around July 9, 2013. 10.Hotel changes: Contact the LRCVB Housing Bureau at 501-376-4781 or by fax at 501-376-4143 to make changes until May 15, 2014. Contact hotel after this date. Hours are Monday-Friday 9 a.m.-4:30 p.m. 8 Crowne Plaza 11.Hotel cancellations: Check with 63rd NSDC® Registration & Housing at registration@63nsdc.com for 9 Hampton Inn West hotel cancellation policy information. The “Diamond Board” of the 63rd National Square Dance Convention® is committed to making our convention fun and enjoyable for you! Call or email us if you have a concern or suggestion. Call 870-834-5362., or email registration@63nsdc.com
luff
530
Hampton Inn West
Single
Holiday Inn Presidential Quad
Comfort Inn & Suites Distance
139.00
139.00
connected
124.95
134.95
1/2 mile
99.00
99.00
6 blocks
Double Triple
119.00
119.00
129.00
129.00
129.00
114.95
114.95
99.00
99.00 10
109.00
79.00
109.00 79.00
119.00 79.00
139.00
129.00 79.00
connected
7 blocks
105.00
105.00
105.00
105.00
8 blocks 5.3 miles
124.00
124.00
124.00
124.00
8 miles
114.00
114.00
114.00
All rates are subject to applicable taxes and fees. **Hotels require a minimum 4 night stay.
114.00
8.2 miles
GSI