ALHAMBRA NIGHT 2012- REGISTRATION FORM
Saturday, July 14, 2012
(Please type your information and print)
Send to: Conchi Madson, 3749 Davenant Avenue, Cincinnati, Ohio 45213
Name:_________________________________________ Dance Name______________________________
Address________________________________________ City:________________ Zip Code____________
Phone__________________________ E-Mail Address___________________________________________
Fee to perform at the show $15.00 ______ ________
(attendace to show free)
Evening show - Adults $18.00 #______ ________
Children under 12 $10.00 #______ ________
Under 5 years - Free
Show video DVD $35 p&h included _________
TOTAL _________
Please Note: No refunds unless event is canceled!
No videotaping of the show permitted - DVD's of the show available for sale to performers/attendees only!
Send Check to: Conchi Madson, 3749 Davenant Avenue, Cincinnati, Ohio 45213
Conchi and Mayerson JCC cannot assume any liability or responsibility for loss of property or injuries incurred by you or others while you are exhibiting, entertaining, performing or otherwise participating in this event. By agreeing to participate, you assume the risk and responsibility for injuries.
