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Registration Form

Phaedra/Samara Workshop

May 2 - 3, 2009

Classes will be held at Sirrom.

No refunds; 

No video cameras allowed in studio.

Print this form and mail to:

Sirrom School of Dance, PO Box 270483, Houston, TX 77277-0483
Name
Street Address
City
State
Zip/Postal Code
Home Phone
E-mail
Sirrom Special - Saturday and Sunday Workshop on or before 4/25/09 -- $135  (no SOS discount) $______________
Sirrom Special - Saturday and Sunday Workshop after 4/25/09 -- $145  (no SOS discount) $______________
Saturday class on or before 4/25/09 -- $75 ($67.50 for SOS member) $______________
Saturday class after 4/25/09 -- $80 ($72 for SOS member) $______________

Gala Show SOS Ticket @ $7.50 (one only)

(Performance by invitation only; performers must purchase an SOS show ticket)

 $______________
Gala Show  ___ Tickets @$15 in advance ($20 at the door) $______________
Sunday class on or before 4/25/09 -- $75 ($67.50 for SOS member) $______________
Sunday class after 4/25/09 -- $80 ($72 for SOS member) $______________
After the workshop video presentation -- free with workshop registration, $10 with no workshop registration.  $______________

Total Enclosed

 

Payment method - Make checks payable to "Sirrom School":

Check

Credit Card
Cardholder Name
Card Number

Expiration Date

If you want to pay by credit card and do not have access to a fax, please call the studio. 

I hereby release Sirrom School of Belly Dance and the workshop instructor for any and all claims for damages or injuries which I/we may sustain while participating in any activity connected with the Seminar.  

  Date

Signature
  Date

Signature

No Refunds and No Video Cameras allowed at workshop and Gala Show.