Please Print and Mail this form with your Check.  Be sure to include the Team or individual participant that you would like us to credit! Please Mail with your check to:
 
iDance4aCURE
20227 Catlett Place
Ashburn, VA 20147
 
Team/Dancer Name to be Credited
________________________________________________________
 
Your Name___________________________________________________
 
Address______________________________________________________

City, State and Zip_____________________________________________
 
Email________________________________________________________
 
Phone________________________________________________________
 
 
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