DARE DAZE 2012
REGISTRATION FORM
Name: _______________________________ Age _______
Address: _________________________________________
City/State/Zip: ____________________________________
Phone Number: (_______)__________________________
Email Address: ___________________________________
Model ______ Photographer ______ Guest _______
Arrival Date: _____________________________________
Departure Date: ___________________________________
Will you be staying at the Host Hotel: Yes_____ No_____
Photographer Registration Fee: $125.00 _______
Model Registration Fee: $50.00 ________
Guest Registration Fee: $50.00 _________
Registration Form and Entry Fee must be
mailed to:
Dare2wear Swimwear Company
12941 Whitfield Drive, Suite 101
Sterling Heights, Michigan 48312