| Registration Form: Director, Teacher and Coach |
| Inspiration for a Lifetime |
|
Printer Friendly Page: Please, (a) print it, (b) fill it out, (c) sign it, and (d) fax or mail it to the fax number or mailing address found on this and on all pages. (See, Contact page.) |
I would like to register for the Youth Ballet Prix in St. Petersburg, Russia 2007
The arrangement I choose:
Spring YBP □ Summer YBP □
Double Occupancy □ Single Supplement □ |
Personal Information: |
| First Name:. |
| Last Name:. |
| Address: Line 1. |
| Address: Line 2 |
| City: | State/Province: |
| Zip/Postal Code: | Country: |
| Tel: | Fax: |
| Email:. |
Ballet School / Ballet Company Information: |
* School/Company Name:
|
| Address: Line 1 |
| Address: Line 2 |
| City: | State/Province: |
| Zip/Postal Code: | Country: |
| Tel: |
* I will accompanied by:
.
.
. |
Method of Payment: |
A. BANK CHECK [USA only].
Enclosed, please find my Full Payment of
payable to: St. Petersburg Ballet Society. | ____________________________ USD |
B. WIRE TRANSFER, Worldwide [USA, too]
I am sending my Full Payment of
payable to: St. Petersburg Ballet Society • | ____________________________ USD |
PNC Bank • ABA #: 031100089 • Account #: 5605849763
PNC Bank, Midway Branch, 4725 Kirkwood Highway, Wilmington, DE 19808 USA |
| I have read, understand and agree to be bound by the Terms and Conditions, especially regarding the Cancellation clause, as stated in the Registration Information. |
| Signature: | Date: |
| . |
* Please, feel free to provide any additional information on your own stationery. |
Thank you for registering! |