Convergence Registration Form 2018
JUNE 14-16 2019

* Please mark yourself as "Going" on the Facebook Event Page:

There will be a day-long intensive on Friday the 14th with CHRISTINE MOONBEAM & BLOX ACROBATICS called Road to Standing Hand to Hand. Please visit the Facebook event to get information and check prerequisites:

*** Please fill out ONE form for PER participant ***

Email address *
Today's date: *
Legal Names (First and Last) *
Your answer
The name(s) you use, if different than above.
Your answer
I have been doing Acro (of any sort) for *
I am based in (or near) *
Which of the following best matches your preferred diet? We are working on getting a food truck or some catering on site - no promises ;)
Please reference the schedule on the website or FB page. Friday is the Day-Long, Saturday & Sunday are the Main Festival.
SOLD OUT ~ FIRST 5 FLASH SALE ----> $150 All 3 days / $100 Any 2 days
~ EARLY BIRD (APRIL 30) ----> $200 All 3 days / $130 Any 2 days/ $70 Any Single Day
~ LAZY BIRD (MAY 30) ----> $215 All 3 days / $145 Any 2 days / $80 Any Single Day
~ REGULAR PRICE** ----> $230 All 3 days / $160 Any 2 days/ $90 Any Single Day
*You MUST meet the prerequisites to take the daylong intensive, Friday June 14th.
**Paying At the Door is cash or eTransfer only (no cards)
***All refunds subject to a $10 processing fee. No refunds after June 13th.
*** Please do not submit this form until you have actually SENT payment to From CANADA: please send via eTransfer. From the USA, please send via PayPal and select "Friends and Family" *
I am attending the Day-Long Intensive Friday June 14th (you must meet the prerequisites). Please keep updated by clicking 'going' on the event page here: *
I will help make Convergence even better next year by filling out the feedback form that will be e-mailed to me after the event!
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY I hereby agree to the following: 1. I am participating in the Convergence Acro Festival by my own free will. During this event I may receive information and instruction about acrobatics, acroyoga, cheerleading, Thai massage and related activities. I recognize that acrobatics, yoga, cheerleading, Thai massage and related activities require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any or all offerings by Convergence Acro Festival, I represent, verify, and warrant that I am physically fit and that I have no medical condition that would prevent my full participation in this event. 3. In further consideration of being permitted to participate in any or all offerings by Convergence Acro Festival, I knowingly, voluntarily and expressly waive any claim I may have against Convergence Acro Festival, or any of their subsidiaries, including the venue Power Cheer Gym and its subsidiaries, for injury or damages that I may sustain as a result of participating in their offerings. 4. I further hereby indemnify and hold harmless Convergence Acro Festival and it’s organizer(s) and affiliates from any and all damages, liabilities, costs and expenses, including reasonable attorneys’ fees, arising out of or relating to any claim by a third party resulting from my practice or instruction in the field of acrobatics, yoga, cheerleading, Thai massage, or related activity. 5. I, my heirs or legal representatives forever release waive, discharge and covenant Convergence Acro Festival, and any of their subsidiaries for any injury or death caused by their negligence or other acts. I have read the above release and waiver of liability and fully understand its contents. *
Want to camp?
There is an 'unofficial' camping event happening for attendees of the festival! Please fill out this Google Form to be contacted by @Mylah Love for booking details.
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