Elisheva
Master Seminar & Showcase
November 5, 2011
Mail-In Registration

Print & Mail to:

Marisa Pierson

2 Maryland Drive

Jackson, NJ  08527

732-905-0059

Classes registering for:

______3-hour Workshop with Elisheva (includes hafla ticket) - $65

Evening Showcase Tickets (indicate number)

_____Family & Friends tickets ($10)

_____Grand Total for Classes and Show

*Please make checks payable to: Farasha and Suad

If you wish to pay be Credit Card, please include the following information:

Credit Card Number (VISA, MC, Discover, AmEx)____________________________
Expiration Date:________________________

3-digit Security No._____________(back of card)

Signature ______________________________

Name:________________________________________________________________

Address: ____________________________________________________________

City, State, Zip:_________________________________________

Phone: ____________________________

E-mail:_____________________________

Do you wish to perform? Yes____ No_____.
(Limited number of dance slots are available, first come, first filled. Only workshop participants are invited to perform in the show!)

Dance Name/ Name of Troupe: (list all performers-use separate sheet if needed) _____________________________________________________________
_____________________________________________________________

Style: (Oriental, Folkoric, Tribal, etc.):____________________Props?_______

Name of Dance Song: ___________________________________________

Length of Dance: (up to 5 min. please) ___________

NO REFUNDS UNLESS EVENT IS CANCELED