Team Name:

School/Studio/Group Name:

Address of School/Studio/Group:

Director’s or Contact’s Name:

Contact information:

Director’s or Contact’s Address:

City, State, Zip Code:

Home Phone:

Email:

Fax number:

Payment Information:

Type of Payment (check one):

__ Studio Check

___Money Order

___ Visa/ Master Card

Visa or Master Card Number:

Security code: _ _ _

Expiration Date:

Name on Card:

Credit Card Billing Address:

City, State, Zip

Signature:

Participants Information:

Number of participants performing  in ONE category:

X $20.00 fee per participant per category:

$

Performers in MORE than one category:      

Totals (should be $20 per person per category):

___________________

___________________

X number of

categories:

Total amount due:

$___________________

$___________________

Performance Group Information:

Number of Members:

Grade/Age:

 Style:                    

Other:

Group 1:         ____________

Group 2:       ____________

Group 3:       ____________

Group 4:       ____________