|
Enlightenment Dance Company Please use your browser's [Print] controls to print this page, then fill in and mail to the address below. |
||
| Register for Workshop Register to Perform Purchase Merchandise Click for Class Registration | ||
| Use this
space to specify workshop, location, or merchandise.
Attach additional sheet if needed.
|
||
| Full name: | ||
| Dance name: | ||
| Street Address: | ||
| City/State/Zip | Country: | |
| Telephone & best time to call: | ||
| email: | ||
|
Enclosed: Check Money order Amount:_____________________ |
||
| Bill me via PayPal I have already paid via PayPal Amount:_____________________ | ||
|
Activities Release: I take responsibility for my Physical
well-being. I represent that I am Physically and Mentally able
to take Enlightenment Dance classes, workshops and to dance or
participate on any event. I release Enlightenment Dance Company,
Rosane Gibson and any other sponsors or representatives and
successors from all claims or liabilities arising out of my
participation in any sponsored activity. Signed:
______________________________________________________
Date: __________________ |
||
| Please make check or money order payable to Enlightenment Dance Company and send to Enlightenment Dance Company 3655 NE 95th Street Anthony, FL. 32617 Phone 863- 585-8264 |
||