CHI-TOWN SQUARES

Crossfire 2019

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Email Address

CLUB AFFILIATION AND DANCE LEVEL

Club Affiliation

Your Highest Dance Level

EMERGENCY CONTACT INFORMATION

Emergency Contact

Emergency Contact Phone Number

(###)

###

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HOUSING

Need Housing?

Housing Dates

Housing Special Requests (pet allergies, non-smoking, etc.)

I am a Chi-Town Member who can provide housing

Number of guests you can accomodate and special instructions