ALHAMBRA NIGHT 2008 -  REGISTRATION FORM

Saturday, July 19, 2008

(Please type your information in the box and print)

Send to:  Conchi Madson, 3749 Davenant Avenue, Cincinnati, Ohio  45213

Name:_________________________________________ Dance Name______________________________

Address________________________________________ City:________________  Zip Code____________

Phone__________________________ E-Mail Address___________________________________________

                 Fee to perform at the show: $5.00                                               ________

                 Fee to purchase Flea Market table $5.00  #tables_______               ________

                 Attend Flea Market $5.00                                                              ________

 

                 Classes (each is $5.00) you may pay at door   #______                   ________

                 Evening show - Adults $15 (free to performers)  #______                  ________

              

                       Children under 12    $5 (under 4 free)         #_______                 ________

                 Show video DVD $35 p&h included                                                _________

                                                                           TOTAL                             _________

                                                                                                               

              

                                                   

Send Check to:  Conchi Madson, 3749 Davenant Avenue, Cincinnati, Ohio 45213

Conchi and The Place cannot assume any liability or responsibility for loss of property or injuries incurred by you or others while you are exhibiting, entertaining, performing or otherwise participating in this event.  By agreeing to participate, you assume the risk and responsibility for injuries.