"Puro Norte" Online Registration Form
Participant Name:
Address:
City, State, Zip:
Email:
Telephone#:
Group Name:
Instructor's or Director's Name:
Dance Level:
T-shirt size:
Additional T-shirts ($15.00 each)
T-shirts purchased on site for $18.00.
Video permit ($25.00) may be purchased on site.
Workshop Fees
Total, Registration Fees:
Total, Video Permits:
Total, Additional T-shirts:
Please indicate additional sizes below:
*Total Amount:
*Name on Credit Card:
*Credit Card Number:
*Expiration Date, Mo./Year:
*Credit Card Type:
*Address:
*Email Address:
* indicates required field.
You will receive email notification once you submit your registration form and payment.
Thank you very much!
Age:
Please Note! The dates of the workshop have changed to Aug. 4 - 7, 2010
