DANCEFEST NEW JERSEY
April 9, 2011
Mail-In Registration

Print & Mail to:

Marisa Pierson
2 Maryland Drive
Jackson, NJ 08527

Tel. 732-905-0059

Classes registering for (check all that apply):
1 class: $30 - 2 classes: $45 - 3 classes: $60 
(hafla tickets included for all workshop attendees. Only workshop attendees will be invited to perform)

_______Farasha (Theatrical Melange)
_______Su'ad (Oriental Melange)
_______Michelle DeVine (Fantasy Melange)
_______Total Class Fee
_______CD of Class Music ($8)
_______Video of the Show ($25)

Dancefest NJ Showcase Tickets (indicate number)

_____Family & Friends tickets ($15)

_____Total Ticket Fee

_____Grand Total for Classes and Show

*Please make checks payable to: Farasha and Suad.

If you wish to pay byCredit Card, please include the following information
You can telephone me with your card info, if you prefer.

Credit Card Number (VISA, MC, AmEx, Discover)_____________________________
Expiration Date:______________

Security code_____________(back of card)

Signature ______________________________

Name:________________________________________________________________

Address: ____________________________________________________________

City, State, Zip:_________________________________________

Phone: ____________________________

E-mail:_____________________________

Do you wish to perform? 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.) _______________________