2008 Emerald Rain Bellydance Competition Registration Form

_____Hestia (Beginner) ~ $45 _____Athena (Pro-Student) ~ $50 _____Aphrodite (Professional) ~ $55 _____Muses (Troupe) ~ $100 _____Sirens (Duets) ~ $75

_____Persephone (Alternative) ~ $50 _____ Minors (17 and younger) ~ $45 _____Majors (45 and older) ~ $50 _____Gypsy/Tribal Soloist ~ $50 _____Duet/Troupe Alternative ~ $100

Dance Name:____________________________________________________________________________________ Real Name:_____________________________________________________________________________________ Address:_______________________________________________________________________________________ Phone and Email:________________________________________________________________________________ I, the undersigned, understand and aagree the Melody Anderson, Emerald Rain Bellydance Co. or anyone working for, with, or connected to the Emerald Rain Bellydance Competition, it's entities, heirs and/or associates will not be held responsible for loss, theft, damage, injury, etc. to my personal belongings or myself. I assume all responsibility and liability for my property and myself. My permission is given for my name, photograph and video tape to be used in publicizing contests, classes and shows in any manner deemed appropriate and the proceeds will be used to promote said contests, classes and shows. Signed:___________________________________________________________________________________________ Signature of Parent/Guardian:________________________________________________________________________

Print page, fill out and send to: Melody Anderson P.O. Box 303 Lynnwood, WA. 98046

~~Please remember that all payments are non-refundable~~ Deadline for entry is February 15, 2008