Flamenco Fan for the Contemporary Dancer Two Day Workshop Series July 15-16th Friday 6:30pm-9pm and Saturday 9:30am-12pm The Cort Gallery Three Rivers $50 for entire series, $40 if you register by July 1st Registration Form please complete all required fields below and click on submit to begin your registration process!  * required Name Age (Note: If under 18 years old, please complete section below entitled Parent or Guardian Permission.  If under 16, please have a parent or guardian call instructor for consultation prior to registering. Thanks!  * required Phone Number  * required Email address (required)  * required Mailing Address (optional) Are you right handed or left handed or can you use both equally well? (for use of fan) Right Handed Left Handed Completely Ambidextrous How did you hear about the workshop?

From a Friend The Cort Gallery Flyer Newspaper Other

Briefly list any dance, martial arts, or movement training or experience you have had in the past below. (This helps the instructor meet the needs of workshop participants) Briefly describe any injuries or illnesses that we should be aware of in the box below. Do you have any questions, comments, concerns, or requests for the instructor? If so, please feel free to list below.

Parent or Guardian Permission Please complete if you are under 18 so that we may contact your parent or guardian to obtain permission for you to participate in the workshop.  Thanks!  * required Name of parent or guardian of particpant listed above  * required Phone Number  * required Email address (required)

Important! After you submit your registration, you will receive an email with further instructions regarding payment. Pre-payment is by check only. Your spot in the workshop will only be reserved once we receive payment. Thank you for joining us!