First Name / Last Name:

Address:

State (US & CA):

Zip Code:

Country:

Gender:

 Female         Male

Date of Birth:

Phone:

Cell/Mobile phone:

Contact Person Name:

(Mother, Father, Sister, Friend):

(In case of an emergency)

Contact Person's Phone: 

(In case of an emergency)

My Dancing Experience

Please Select 2-3 years 3 - 5 years more than 5 years professional dancer

Presently Training At:

Any disability? (If yes, please specify here)

Where did you hear about SIBA workshops?

(please choose from the list, or write in the Remarks section.

  Please Select I am a SIBA student From EDAS website Received an e-mail From Facebook From my dance teacher I Searched the Internet From one of the workshop teachers From a friend Other

Need Accommodation: (A room in a shared apartment)

Yes          No

Additional information or remarks:

 *By submitting this form I agree to pay the the required tuition fees for any of the workshops I have registered to here. No refund if cancelled more the 2 weeks before each workshop

* Online payments by credit card will be charged 3.5%.

I will pay the deposit by:  Credit Card Bank transfer  Cash on arrival

*You will receive an email confirmation with instructions how to pay.