| Miami Bellydance
Convention Suhaila's Workshop Registration Form Saturday August 23rd 2008 Intercontinental Hotel 100 Chopin Plaza, Miami FL 33131 |
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Registration
starts 10:30 am workshop begins 11:00am |
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| I have read the following: Please send your payment along with this registration form and complete all of the information requiered. Money is refundable if workshop is canceled for any reason, but is not refundable if you do not attend it. | ||
| Full name: | ||
| Dance name: | ||
| Street Address: | ||
| City/State/Zip | Name of school registration : | |
| Telephone & best time to call: | email: | |
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Please indicate your choice of payment:
$120 Early registration (Ends August 15th 2008) $140 Registration at the door or (after August 15th 2008) $75 Morning session 11:00am-2:00pm $75 Afternoon session 3:00-6:00pm |
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| Enclosed: Check Money order Amount:_____________________ | ||
| I have already paid via PayPal- Copy of receipt attached. Amount:_____________________ | ||
| Activities Release:
I take responsibility for my Physical
well-being. I represent that I am Physically able
to take Suhaila's dance Workshop. I release The Miami Bellydance
Convention , Nathalie Zarate, Suhaila Salimpour and any other sponsors
or representatives and successors from all claims or liabilities arising
out of my participation in any sponsored activity. Signed: ______________________________________________________ Date: __________________ |
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---------------------------Please
keep and present this portion at the door------------------- |
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