| Registration Form: Participant |
| 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
Spring YBP □ Summer YBP □ |
Personal Information: |
| First Name: |
| Last Name: |
| Address: Line 1 |
| Address: Line 2 |
| City: | State/Province: |
| Zip/Postal Code: | Country: |
| Tel: | Fax: |
| E-mail: |
| Date of Birth: | day | month | year |
Spring YBP - Age on 12 March 2007:
Summer YBP - Age on 18 June 2007: | Female □ | Male □ |
Parent/Guardian Name:
. |
* I will be accompanied by:
. |
* My School/Company:
. |
* My Ballet Teacher:
. |
| Category I enter: | Solo □ | Duo and Trio □ | Ensemble □ |
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, as stated in the Registration Information. |
| Signature: [Parent or Guardian - Under Age 18] | Date: |
| . | . |
* Please, feel free to make additional notes and comments on your own stationary. |
Thank you for registering! |