Wings Over Connecticut with
AYSHE
March 17, 2012
Mail-In Registration

Print & Mail to:

Nancy Barrett
P.O. Box 465
Hebron, CT 06248
Tel. 860-604-5364

Classes registering for:

______Seminar with AYSHE (includes show ticket) - $70

Evening Showcase Tickets (indicate number)

_____Family & Friends tickets ($12)

_____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
You can telephone me with your card info, if you prefer.

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.