First Name:

Last Name:

Gender:

 Female         Male

Address:

State (US & CA):

Zip Code:

Country:

Date of Birth:

Phone:

Cell/Mobile phone:

Contact Person Name:

(Mother, Father, Sister, Friend):

(In case of an emergency)

Contact Person's Phone: 

(In case of an emergency)

I would like to participate for:

Please select2 weeks3 weeksfull program

Dates you would like to participate in: 

My Dancing Experience

Less then 1 year1 - 2 years2-3 years3 - 5 yearsmore then 5 yearsprofessionall dancer

Presently Training At:

Any disability? (If yes, please specify here)

Where did you hear about SIBA workshops?

(please choose from the list, or write in the Remarks section.

 Returning SIBA studentFrom EDAS websiteReceived an e-mailFrom my forumAd in a MagazineFrom my dance teacherI Searched the InternetFrom one of the workshop teachersOther

OPTIONAL ADDITIONS:

Accommodation at dormitory: -  €350 /month (including daily breakfast)

 Yes

No

Maybe

Accommodation Private Room:  €450 /month

Yes

No

Maybe

Additional information or remarks: (also if you come with a chaperon, write here please)

 *By submitting this form I agree to pay the registration/Processing fee of €300 (*150 Euro Refundable only if cancelled before May 31, 2008)  upon registration, in order to secure my place. The balance to be paid on arrival in Salzburg.

* Online payments by credit card will be charged 3.5%.

* By submitting this form I agree to all terms and conditions specified in the prices page:

I will pay the deposit by:  Credit Card Bank transfer  Check/money order

*You will receive an email confirmation with instructions how to pay.