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E-Form

If you'd like to register for camp electronically, please fill out the form below. Note that we cannot accept credit card payments using this form. The basic idea is that you'd need to

  • Fill out the form
  • Deposit payment for camp into our bank account

Our bank account details are as follows:
Machol Pacifica BOP 2011
Kiwi Bank (Wellington)
Account number: 38 9011 0302750 00

Please make sure that any payments to our account are identified with your name so that we know who the payment has come from

This registration form has gone out early in order for people to know exact days & times for the dance weekend so flights can be booked as the rugby world cup is during this time. We will update in april for t shirts & media costs.

Note that fields with a * must be filled in.

First Name*:  

Surname*:  

Email Address*:  
If the email address above is not correct, we will not be able to respond to your message.

Postal Addresss*:

Home Phone*:  

Cell Phone:  

Full Bird Registration (Includes lunches, morning & afternoon tea breaks and suppers) $80.00
Note that Early Bird registration closes on 1st July. After that, registration will be $90.00

Saturday Only Registration (includes lunch and tea breaks) $45.00

Friday Afternoon Dance Option: Would you be interested in an extra session with Pamela on Friday from 4:00pm - 5:30pm? Yes No

Saturday Afternoon Options
Option 1: Later Saturday aft. sightseeing trip/ Awakeri Hot Pools & Picnic Dinner (*Please remember to bring swim wear) ($35.00)Yes No
Option 2: Awakeri Hot Pools swim & Picnic Dinner ($30.00)Yes No
Option 3: Awakeri entry (non swimmer) & Picnic Dinner ($25.00)Yes No

Media and Resources
CD($20.00)Yes No
DVD($25.00)Yes No

T-Shirt ($28.00)- Cream T shirt with scoop neckline, fitted unless requested Yes No

Size
S      M      L      XL      XXL     

Total Payment

Date Paid

Do you need a receipt?Yes No

Would you like an email Acknowledgement?Yes No

Anything else we should know? (Comments):

We've been receiving spam through this website. To help us combat this problem, please type in the name of the city where dance camp is being held this year. Remember to use a capital for the first letter.  

Please register by 31st August

Cheques payable to: Machol Pacifica BOP 2011 & please post with completed Registration form to: Faye Falloon, 31 Athfield Drive, Bethlehem, Tauranga.
Any questions, please feel free to contact us: Faye 07 579 2636 Maria 07 544 1680 Beryl 07 307 2315a/h
Please be aware that if you cancel your attendance before 30th July you will be refunded in full. However, if you cancel between 30th July and 31st August we may have to charge a 20% cancellation fee. Unless you have a serious reason any cancellation after 31st August will not be refunded.