REGISTRATION FORM BREAK OUT: Dance Program in ITALY
Program Runs: Aug 10-25, 2019
Name *
first and last
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Email *
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Phone *
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What stage of training are you in? *
Accommodation *
The apts provided by the program for the 2 weeks are 350 euros. Generally 2 dancers per room. A smashing deal, we know! (You will pay for apartments in euros when we arrive on 8/10/19. You can exchange this money in the US or at the airport when you arrive in Italy)
If you know the name of another dancer attending the program you would like to room with please list their NAME and EMAIL below:
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Registration Payment Info: DUE: MARCH 1 *
Mailing Address: Amalgamate Dance Company, 55 Overlook Terrace #7F, New York, NY 10033
Sponsorship Request Paragraph
We sponsorship funds available. 1) Please tell us why you need to attend BREAKOUT and 2) what amount you can afford in registration fees?
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Your e-signature below signifies that you have read and agree to the following: I hereby release Amalgamate Dance Company (ADC), its instructors, directors, technical crew and all rehearsal, performance, class, and event locations from any liability due to personal injury or loss of property, which I may sustain as a result of participating in any activity with the Company. Part II Photo/Video Waiver: I hereby give permission to Amalgamate Dance Company to use photographs and video that I submit to the company for use on ADC's Website and/or within any other promotional materials. As well, as photographs and video taken of me while dancing with the Company. Thank you! THE BREAKOUT & ADC TEAM *
(full name)
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How did you hear about this program? *
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