First Name (or nickname)
Last Name
Name on Credit Card
Billing Address
City
State
Zip Code
Work Phone
Home Phone
.
E-MAIL
.
Gender	Select Male Female
(for seating purposes) Age	Select 35-39 40-44 45-49 50-54 55-59 60-64 65+
How did you hear about this event?

Payment Information
Number of Persons you are Reserving for
If you are paying for a friend, enter their name(s) (First & Last Name) (for seating purposes) Age of Friends
	VISA MasterCard
Total Amount
Credit Card Number
Re-enter your Credit Card Number
Expiration Date	mm 01 02 03 04 05 06 07 08 09 10 11 12   yy 2007 2008 2009 2010 2011 2012 2013
SUBMIT FORM - BELOW
Disclaimer: By submitting your reservation below and in consideration of Upscale Singles of Maryland, Inc. allowing the registration and attendance of the above registered member(s) and/or guest(s) to an event as scheduled and/or operated by Maryland's Upscale Singles, the above registered member(s) and/or guest(s) does hereby expressly release and discharge the said Maryland's Upscale Singles from any liability whatsoever, and does further waive any claim against the said Maryland's Upscale Singles on account of any claim, cause of action or suit for personal injuries of any type arising out of services provided or sponsored to the above registered member(s) and/or guest(s) by Upscale Singles of Maryland, Inc. I agree that the submission of this form indicates I have read and understand the above disclaimer.
Reservation Cancellation Policy Reservations are accepted on a first come, first served basis and may be subject to limited availability by gender. Cancellations must be made at least one week before an event to receive full *credit toward a future event. If cancellation is made within three days prior to an event, and you are able to find someone to take your place, you will receive full credit toward a future event. If we are unable to fill your seat or if you are a no-show, no refund is given. If you cancel more than three events within a one-month period, you will be assessed a $25 service charge.  *Credits are kept on your Upscale Singles account to be used for future events. Credits not used within 90 days are subject to forfeiture.