Presented by Canyon Movement Company, Canyon Dance Academy, and Coconino Community College.                

July 11-17, 2010

REGISTRATION FORM (Copy and paste into a word document, print it and MAIL WITH CHECKS PAYABLE TO:

  

Canyon Movement Company

5680 East Sunset Drive

 Flagstaff, Arizona 86004

 Once payment is received a detailed schedule will be sent to each registrant.  

 For questions call 928.774.3937

or email  canyondance@live.com

 

Workshop  Pass — $525 before May 13 or $550 after May 13

 T-shirt - $15

 

Total enclosed: $_________________

 ___________I will be coming from out of town. 
___________Yes, I need housing. Contact me about staying with a host family. 
___________I will arrange my own housing.

      

Name                                                              Age :                          

Parent's name (if applicable)                                                           
Email:                                                                                                
Address:                                                                                             

City, State, Zip:                                                                                   

Phone number:                                     Alternative #                          

Emergency contact:                              Phone number:                        

 Due to the physical nature of dance, I agree to hold harmless Canyon Dance Academy, Canyon Movement Company, S&G Property Management, and/or any instructors at this studio for any accidents or injuries which may occur while taking classes here, whether they happen in class, before or after class, in performance, and/or in an alternative space.

Signature  ______________________________________________Date _________