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________________________________________________________