EmailMe Form - 30th Annual Summer Workshop

Student Name

First Last

Student Age *

Date of Birth *

Parent Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone Number *

### - ### - ####

Emergency Contact *

First Last

Emergency Contact Phone *

### - ### - ####

If you would like to pay by check, please select this box ONLY

Pay By Check Weeks 1 & 2

Weeks 1 & 2 July 8-12 and 15-19 ($1314.00)
Guest Faculty: Rieko Hatato, (both weeks) Dustin Gerardine (Week 1) Elliott Trahan (Week 2)

Pay Online

Previous Training/Current Level *

Years en pointe *