Special Events Form

Must be received by the 20th of the month. Two months before the event (I.E. March 20th for the May issue)

A special event MUST meet at least one of the following criteria to qualify:
Check the appropriate number below:

State or Regional Federation function
The ROUNDUP subscription dance
Event sponsored by a State Federation affiliated Caller or Cuer organization
Benefit dance (fund raiser for a worthy cause)
Free promotional dance (street dance, county fair, etc.)

 

ROUNDUP issue: Club Name:

Check the appropriate items below:

Region CE
 CW
 NE
 NW
 SE
 SW
Day of the week Monday
 Tuesday
 Wednesday
 Thursday
 Friday
 Saturday
 Sunday
Week(s) of the Month 1
 2
 3
 4
 5
 Every
Dance Level ND
 MS
 PLUS
 A1
 A2
 C1
 C2
 RD
 CW
 Folk
 Clogging

Fill in the appropriate information below

Date of Dance:
Facility:
City/State:
Address:
Directions:
RD Cuer: Time:
SD Caller: Time:
Lunch Details:
Purpose of Event:
Contact Information:

Submitted By:

Name:
Address:
City / State / Zip Code:
Phone Number (with area code):
Email Address: