BALLET SEMINAR

2012 BALLET SEMINAR APPLICATION | REGISTRATION FORM            
2012 Ballet Seminar Registration Form PDF

*Required Field    
EVENT*
JULY 10-15, 2012 | LAS VEGAS, NV    
APPLICANT STATUS* (Select one)
DEA MEMBER STUDENT DEA NON-MEMBER STUDENT  
INSTRUCTIONS
Submit completed application, Copy of Scholarship Form (where applicable) & Notarized Medical Release Form for all participants under the age of 18 is required along with a copy of a Birth Certificate. Keep a copy of application for your records. All registrations will be confirmed once all documents and full payment is received. Participants unable to attend due to injuries or serious illness after registration must send by fax or mail, a signed Doctor’s certificate stating medical reason for cancellation and a processing fee of $50.00 will be withheld from total registration and balance applied to 2013 Ballet Seminar. No handwritten forms may be substituted. Absolutely no refunds.
APPLICANT INFORMATION*
Student First Name: Student Last Name:
Date of Birth: Home Phone: Cell Phone:
Mailing Address:
City: State: Zip code:
Emergency Contact: Emergency Phone:
E-Mail:

SCHOOL INFORMATION*
Instructor First Name: Instructor Last Name:
Studio Name: Studio Address:
City: State: Zip code:
Work Phone: Work Fax: E-Mail:

2012 TUITION* (**Scholarship Form copy required)
BEFORE MAY 18, 2012
AFTER MAY 18, 2012
Full Price
$550.00 
$650.00
MEMBER
Half Scholarship*
$275.00
$325.00
Full Scholarship*
$    0.00
$    0.00

Full Price
$600.00
$700.00
NON-MEMBER
Half Scholarship*
$300.00
$350.00
 
Full Scholarship*
$    0.00
                          $    0.00
OBSERVER
Teachers Only
$100.00
$150.00

PAYMENT
TOTAL COST $ 

APPLICANT'S SIGNATURE (If Student is Under 18 yrs of Age, Parental Signature is Required)
 
Applicant's Initials*: