ALHAMBRA NIGHT 2010 -  REGISTRATION FORM

Saturday, July 17, 2010

(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                      ______                  ________
                         (Attendance to the show is free if you perform)  
                                                              
                 Evening show - Adults $15 (free to performers)  #______                  ________

                                  Children under 12   $10.00             #______                  ________
                                  Under 4 years - Free
                          (Beer, pop and snacks included!)

                 Show video DVD $35 p&h included                                                _________

                                                                           TOTAL                             _________
                                                                                                                                                                Please Note:       No refunds unless event is canceled!                                                   
                          No videotaping of the show permitted - DVD's of the show available for sale to  performers/attendees only!
                         

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.