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Medal Night Sem 1 2017 Sign Up
Friday 19th May 2017 (Week 11), doors open at 5:30pm, starting at 6pm, expecting to finish at 9pm

Glen Waverley Community Centre
700 Waverley Rd
Glen Waverley VIC 3150

Half Bronze: $10
Full Bronze: $15
Half Silver: $15
Full Silver: $25
Half Gold: $20
Full Gold: $35

Full Name
Your full name (please ensure this is spelt correctly, as this is what will be on your Medalist trophy):
Your answer
Student ID
Your answer
Mobile number
Your answer
MDS membership number
Your answer
Medical conditions
For OH&S requirements, please provide details of any medical conditions (e.g. asthma, diabetes) that may affect your participation in the event, with or without prior notice:
Your answer
Which Medals will you be completing?
Select all applicable:
Do you know who will be partnering you for your Medal(s)? (No stress if you don't; we will sort things out! :D)
Your answer
Your contact email
Your answer
(For Performers) Which Class Routine Are You Dancing?
Anything you would like to add? And be pumped!
Your answer
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