Aszmara
Septemer 6, 2008
Mail-In Registration

Print & Mail to:
Marisa Pierson
2 Maryland Drive
Jackson, NJ 08527

(732) 905-0059

Number for Workshop & Hafla @ $65_________

Number of additional Hafla Tickets @ $15____________

(**DVD/Video of the Entire Show will be available for $25)

DVD Video of Afternoon Show @ $25_______________

Grand Total Classes, Show & DVD $____________

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Make checks or money order payable to: Marisa Pierson
(VISA, Mastercard and Discover also accepted)

Card Number:______________________________________________

Expiration date: ____________________________

Signature: ___________________________________________________

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Name:________________________________________________________________

Address: ____________________________________________________________

City, State, Zip:_________________________________________

Phone: ____________________________

E-mail:_____________________________

Would you like to Perform in the Hafla? Yes_______No______

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

Style: (Oriental, Folkoric, Tribal, etc.):______________________________________

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