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| | | | | | Return All Forms and Files Page | | | | | |
| | ENSEMBLE Registration Form | |
| | Printable Web Pages | Three ( 3 ) Pages: | |
| | 1. ENSEMBLE Registration Form | 2. Dancer Information Form | 3. Release Agreement | |
| | Please, F AX the Registration Form to one of the FAX numbers: | |
| | TOKYO: +81-3-4496-4764 ▪ NEW YORK: +1-212-937-3503 ▪ VIENNA: +43-1-253-03330017 | |
| | HONG KONG: +852-3017-6885 ▪ MEXICO CITY: +52-55-1084-3009 ▪ MUMBAI (BOMBAY): +91-22-6645-9889 | |
| | DANCE PRODIGY, 590 Madison Avenue, 21st Floor, New York, NY 10022 USA
E-mail: admin@ibsdp.org ▪ Website: www.ibsdp.org ▪ Telephone: +1-212-504-3246 ▪ Fax: +1-212-937-3503 | |
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| | Please, use the ENSEMBLE Registration Form for DUO ▪ TRIO ▪ ENSEMBLE 1 ▪ ENSEMBLE 2 | |
| | Please, duplicate these pages for the data of additional number of Dancers of the Ensemble. | |
| | DUO: □ | TRIO: □ | Total Number of Dancers: | |
| | ENSEMBLE 1: □ | ENSEMBLE 2: □ | Form Page Numbers: | |
| | | |
| | DANCE SCHOOL NAME: | |
| | Director: First Name | Middle Name | Last Name | |
| | Address | |
| | City | State/Region | |
| | Zip/Postal Code | Country | |
| | Telephone: | Fax: | Mobile: | |
| | E-mail: | Website: | |
| | | |
| | Dance Entry Title:: | |
| | Dance Entry Style | |
| | Choreography by | Staged by | |
| | Dance Teacher: First Name | Middle Name | Last Name | |
| | Dance Coach: First Name | Middle Name | Last Name | |
| | | |
| | 1. Dancer: First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | 2. Dancer: First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | 3. Dancer: First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | 4. Dancer: First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | 5. Dancer: First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
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| | PARTICIPATION FEE: ALL INCLUSIVE — Includes All Communication, Processing and Participation Costs. Non-Refundable. | |
| | DUO / TRIO: USD $100 per dancer | ENSEMBLE 1: USD $75 per dancer | ENSEMBLE 2: USD $50 per dancer | |
| | * Payment Method — International — Bank Wire Transfer — Bank Wire Transfer Information: | |
| | Swift Code: PNCCUS 33 | Bank Name: PNC Bank | Bank Account: ABA #: 031100089 Account #: 5607601577 | | |
| | Bank Account Holder: International Ballet Society | Bank Account Address: 590 Madison Avenue, 21st Floor, New York, NY 10022 USA | | |
| | Bank Branch Address: PNC Bank, 17725 Coastal Hwy, Lewes, DE 19958 USA | For: Registration | | |
| | * Payment Method — USA Only — Check on USA Bank or Money Order: | Payable to: International Ballet Society | | |
| | Mail to: DANCE PRODIGY, 590 Madison Avenue, 21st Floor, New York, NY 10022 | Telephone: +1-212-504-3246 | | |
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| | Please, FAX a signed copy of the attached Release Agreement with the Registration Form. | |
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| | Signature: Ballet School Director or Parent/Guardian | Date | |
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| | | | | | Please, Continue to the Dancer Information Form Page → | | | | | |
