In support of the event, your local retailers will be awarding scholarships. For the list of supporting retailers, please visit the registration webpage. Please visit your local retailer to complete the scholarship application form.
Please provide the following contact information:
Name Street Address Address (cont.) City State/Province Zip/Postal Code Home Phone E-mail • Must be 16 years of age or older to attend as a teacher • The Heartbeat of Dance is not responsible for participants supervision, a chaperone 18 years or older is required. • NO refunds on registration fee • Only the registered/paid teachers or studio owners are allowed to take classes. Observers are only allowed to watch. • All students must dance in the room designated by their wristband • Faculty is subject to change I, , on behalf of the parties registered, give full permission to The Media Connection USA, Inc. to use their images for advertising purposes. Furthermore, I understand that The Media Connection USA, Inc., the directors, workshop site, hotel, staff, and faculty are not liable for personal injuries, or loss or damage of personal property. Students may at any time refuse to participate in any of the activity. Please inform teachers of any physical limitations you may have. HOTEL INFORMATION Hotel info: Hyatt Place Lakeland Center, Contact person: Mike Franck, (O) 863-413-1122 (F) 863-413-1133 michael.franck@hyattselect.com, Group Name: The Heartbeat of Dance Block Dates: good thru Aug 25, 2008 Block Dates: Sept 26 and 27, 2008 Room rates are $109.00 single/double and $119.00 Triple/quad. Large Group Discounts 16 -25 Students = 1 Free Teachers 26 - 40 =2 Free Teachers 41 and above contact the number above for more information
I, , on behalf of the parties registered, give full permission to The Media Connection USA, Inc. to use their images for advertising purposes. Furthermore, I understand that The Media Connection USA, Inc., the directors, workshop site, hotel, staff, and faculty are not liable for personal injuries, or loss or damage of personal property. Students may at any time refuse to participate in any of the activity. Please inform teachers of any physical limitations you may have.
HOTEL INFORMATION
Hotel info: Hyatt Place Lakeland Center,
Contact person: Mike Franck, (O) 863-413-1122 (F) 863-413-1133
michael.franck@hyattselect.com,
Group Name: The Heartbeat of Dance
Block Dates: good thru Aug 25, 2008
Block Dates: Sept 26 and 27, 2008
Room rates are $109.00 single/double and $119.00 Triple/quad.
Large Group Discounts
16 -25 Students = 1 Free Teachers
26 - 40 =2 Free Teachers
41 and above contact the number above for more information
Location:
Florida - Sept 27 and 28, 2008 Instructors Lauren Gottlieb, Dominic Sandoval, Hokuto Konishi "Hok" Jersey, Kenney Wormald, and Chio
Florida - Sept 27 and 28, 2008 Instructors
Lauren Gottlieb, Dominic Sandoval, Hokuto Konishi "Hok"
Jersey, Kenney Wormald, and Chio
Choose one of the following options:
Juniors: 9-15 Seniors:16 and up
Dancer Observer Teacher If with group state the group name: Please fill in the store you buy dance wear from:
Dancer Observer Teacher
Please fill in the store you buy dance wear from:
