Registration Form for SIBA Summer Intensive Workshop

First Name:

Last Name:

Address:

State (US & CA):

Zip Code:

Country:

Gender:

 Female         Male

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)

How many weeks?

 Please selectfull program3 weeks2 weeks

Dates you would like to participate: 

My Dancing Experience

Please Select2-3 years3 - 5 yearsmore than 5 yearsprofessional 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.

 I am a returning SIBA studentFrom EDAS websiteReceived an e-mailFrom an Internet ForumFrom FacebookAd in a MagazineFrom my dance teacherI Searched the InternetFrom one of the workshop teachersFrom a friendOther

ROOMS & MEALS:

Accommodation at dormitory 

and full meals plan:

Yes

No

Accommodation Private Room Addition:  €100 /month

Yes

No

no thanks

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 (*Refundable 50%  if cancelled before May 31, 2010)  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 

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