REGISTRATION FORM
Name_____________________________________________________________________
Address___________________________________________________________________
_______________________________ Zip Code___________________________________
Phone #________________________ e-Mail Address_____________________________
Retreat Price: $250.00 Deposit: $50 (Balance due: April 15, 2015)
Single room Supplement add $50.00
(Limited availability)
Make checks payable to: Belly Dance Enterprises
7464 Sleepy Hollow Drive
West Chester, Ohio 45069
I will perform at the Hafla (maximum 5 minutes) Yes_____ No______
(Only for dancers attending the entire week-end)
Soloist name________________________________________________
Troupe name________________________________________________
Roommate request:___________________________________________
Vegeterian Meal: Yes__ No__ I am a night owl__ Early bird__
SORRY, no refunds unless you fill your spot or we are sold out!
