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Registration Form Leila Gamal Workshop Oct. 16 - 18, 2009 |
Classes will be held at Sirrom. |
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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
| Friday night class -- $40.00 (no SOS discount/no early price) | $______________ | |
| Sirrom Special - Saturday and Sunday Workshop on or before 10/11/09 -- $135 (no SOS discount) | $______________ | |
| Sirrom Special - Saturday and Sunday Workshop after 10/11/09 -- $145 (no SOS discount) | $______________ | |
| Saturday class on or before 10/11/09 -- $75 ($67.50 for SOS member) | $______________ | |
| Saturday class after 10/11/09 -- $80 ($72 for SOS member) | $______________ | |
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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 10/11/09 -- $75 ($67.50 for SOS member) | $______________ | |
| Sunday class after 10/11/09 -- $80 ($72 for SOS member) | $______________ | |
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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, anyone associated with the studio, 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/Show. If registering for troupes and/or students, all need to sign the release. Thank you.
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Registration is non-refundable and nontransferable.
No video recording devices (video cameras, phone recording, etc.) are allowed at workshop.
People video taping without permission will be asked to leave and the admission will not be refunded.