Jersey Boyz seminar and showcase
Septemer 11, 2010
Mail-In Registration

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

(732) 905-0059

Total Package:
Tarik Egyptian Shaabi Class and Break it Down! Class with Carmine & Tarik

includes Showcase Ticket  @ $90 _____________ (must receive by Sept. 3, 2010)

Tarik Egyptian Shaabi Class plus showcase ticket @ $65______________

Carmine & Tarik Break it Down Class plus showcase ticket @ $45_________

Number of additional Showcase Tickets @ $15____________

DVD Video of Show @ $25_______________

Grand Total Classes, Show & DVD $____________

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Make checks or money order payable to: Farasha and Suad
(VISA, Mastercard, Discover and AmEx also accepted)

Card Number:______________________________________________

Expiration date: __________________________3-digit Security Code________

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) _____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Name of Song/Music:__________________________________________________

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

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