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Chanson De Vie Dance Studio
Seminar Form

Chanson de Vie Dance Studio Presents
Bahaia & Melissa-Amira
 

January 24, 25, & 26, 2003

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Please fill out the form below.  If you are paying by:
 
Check - Print out the form before you hit the submit button, sign the bottom, and mail it with your check to:
 
Paypal - You will be asked to sign a release form at the door.
 
Chanson de Vie Dance Studio
18047 Point Lookout Drive
Nassau Bay, TX  77058
 

Name
Address
State and Zipcode
Please include me in future Chanson de Vie mailings.
Dance Name
Yes, I would like to perform in the Saturday Night show.
Two day special, Saturday and Sunday, $90.00
Friday evening, separate, $15.00
One day only, $55.00. Please specify which day.
Performer show ticket, $5.00
Saturday Night Gala Show ticket, $10.00 per ticket. Please specify number of tickets.
I am paying with Paypal.
I am paying with a check.
Total amount enclosed.
  

I will not hold Chanson de Vie Dance Studio or any of its affilliates responsible for loss of personal effects or personal injuries (if any) while attending either the three-day seminar or Gala Show.
 
 
 
Signature:                                                                                            
Date:                                                      

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