Registration Form
Saturday Workshop pre-registered* $65 At the door - $75 ______________________________
Saturday Show - $10.00 ________________________________________________________
Sunday Workshop - pre-registered* - $45 At the door - $60 _____________________________
Whole Weekend - pre-registered* - $100, At the door - $120 ____________________________
Video $25.00 _____________________________________________
Name/Stage Name/Troupe_____________________________________________
Address ________________________________________________________
City____________________________State_______Zip___________
Phone_________________________ cell_______________________
Email ________________________________________________________
*Pre-registered postmarked March 30, 2016
I take responsibility for my Physical well being. I represent that I am Physically
and Mentally able to take these classes. I release
Florence Parks and Recreation Department, City of Florence, Lauderdale County,
Wiporwil,
Noelle Smith, Mésmera, and all sponsors, their representatives and
successors
from all claims or liabilities arising out of my participation in this event.
Observers Fee Same as Participant
Signed _______________________________________________________________
Dated _____________________________
Please make checks payable to
The Florence Department of Parks and Recreation,
300 Broadway Street, Florence, AL 35630