Vashti June 2008 Registration Form

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Registration Form

Vashti Workshop

June 28, 2008

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

	Saturday class on or before 6/21/08 -- $60 ($54 for SOS member)	$______________
	Saturday class after 6/21/08 -- $70 ($63 for SOS member)	$______________
	Anniversary Show SOS Ticket @ $7.50 (one only) (Performance by invitation only; performers must purchase an SOS show ticket)	$______________
	Anniversary Show ___ Tickets @$15 in advance ($20 at the door)	$______________
	Total Enclosed	$______________

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

Check

Credit Card

Cardholder Name

Card Number

Expiration Date

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.

Name
Street Address
City
State
Zip/Postal Code
Home Phone
E-mail

Check
Credit Card
Cardholder Name
Card Number
Expiration Date