PERFORMANCE ARTS SEMINAR REGISTRATION FORM | |||||||||
|
FEES Dance Alliance Members...$40.00 Non-Members.......$55.00 Regular registration (postmarked Jan 31-Feb 14) Dance Alliance Members...$50.00 Non-Members.......$65.00 White Rabbit registration (after Feb 14) Call 885-6073 before Feb 22 to determine if space is still available Dance Alliance Members...$65.00 Non-Members.......$80.00 |
Make check payable to: Dance Alliance Mail to: Dance Alliance Performance Medicine Seminar PO Box 372 East Greenwich 02818 Any questions? Call 401-885-6073 or email hscheff@cox.net | ||||||||
|
PLEASE PRINT CLEARLY NAME: _________________________________________ PHONE: Day______________________Night__________________ EMAIL:_______________________________ MAILING ADDRESS: Street wt number or PO: ____________________________________________________ City: ________________________ State: ______________ Zip: ___________ SCHOOL/STUDIO/ORGANIZATION AFFILIATION (if any) __________________________________________ ___________ I am a current member of Dance Alliance ___________I would like to join Dance Alliance at this time (Optional) (DA Membership fee is $30.00. Join now and come to the seminar at the applicable DA rates above)
This registration will print as two pages. Please staple them together and make sure your name is on both pages before submitting. | |||||||||