Dance to save lives

Vinn Pran Bagèt Dance Retreat Registration Form

Registration Fee: $75(Non Refundable)
Full Name *
First Name Last Name
Gender *

Female Male

Address

Age
Home Phone Number
Cell Phone Number
- Country Code - Area Code Phone Number
E-mail *
*(If you are under 18 years old)
*Full Name
First Name Last Name
*Parent/Guardinan Full Name
First Name Last Name
*Enter the message as it's shown *
How did you hear about Vinn PranBagèt Dance retreat? *
If your answer is Other, please list here
What is your drum/dance experience?
Are you a Vegetarian? *

Yes No
Allergies
Any Medical Conditions or concerns?
*Cancellation/Refund policy: If you have to withdraw from Vinn Pran Bagèt Dance Retreat for any reason before May 30th you will be refunded 50% of your tuition. Tuition will not be refunded after May 30^th.
Entering my name into the text box below will qualify as my signature stating that I have read and agree to the attached policies.
Signature Name *
Date
- Day - Month Year
Registration Fee *
Vinn Pran Bagèt Dance Retreat Registration $ 75.00 USD
Should be Empty:

Dance To Save Lives