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| | | | | | Return All Forms and Files Page | | | | | |
| | SOLO Registration Form | |
| | Printable Web Pages | Two ( 2 ) Pages: 1. SOLO Registration Form | 2. Release Agreement | |
| | Please, FAX 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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| | DANCER: | |
| | First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | Dance School Name | |
| | Director: First Name | Middle Name | Last Name | |
| | Dance Teacher | Dance Coach | |
| | | |
| | DANCE SCHOOL CONTACT INFORMATION: | |
| | Address | |
| | City | State/Region | |
| | Zip/Postal Code | Country | |
| | Telephone: | Fax: | Mobile: | |
| | E-mail: | Website: | |
| | | |
| | DANCER CONTACT INFORMATION: | |
| | Address | |
| | City | State/Region | |
| | Zip/Postal Code | Country | |
| | Telephone: | Fax: | Mobile: | |
| | E-mail: | |
| | | |
| | DANCE ENTRY INFORMATION: | |
| | Dance Solo Title: | |
| | Dance Solo Style:: | |
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| | Choreography by | Staged by | |
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| | PARTICIPATION FEE: USD $150 — ALL INCLUSIVE — Includes All Communication, Processing and Participation Costs. Non-Refundable. | |
| | * 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: Dance School Director or Parent/Guardian | Date | |
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| | | | | | Please, Continue to the Release Agreement Page → | | | | | |
