Gaby's Dance Studio Club Inc.

Open Dance Competition & 12th Birthday Ball - Saturday, 28th July 2012
Olympus Room, Hellenic Club, 1 Matilda St. Woden ACT, Australia

(Fill in one form per person,  then SUBMIT to us with your payment)

Name:    

Address: Post Code:

Email:      Phone: Mobile:

Ticket Information

Ticket type: (Select ticket type required) Competition and Ball $128 Ball Only (& Competition Spectator) $98 Spectator Only (Competition) $25 (Choose your Ball Meal) Vegetarian Carnivore Gluten Free Lactose Free

Competition Entrant Information

Please complete the below form for the events you would like to compete in

West Coast Swing

Freestyle: (Choose Level) West Coast Swing 1 - Beginner West Coast Swing 2 - Intermediate West Coast Swing 3 - Advance West Coast Swing 4 - Masters (teacher and former winners) Partner:

Dance with a stranger: (Choose Level) DWAS 1 - Beginner DWAS 2 - Intermediate DWAS 3 - Advance + Masters (2+ years)

Battle of the Sexes: Battle Of The Sexes Male pair Female pair Partner:

Latin American - Jive, Rumba & Cha Cha Cha

Freestyle: (Choose Level) Latin American 1 - Beginner Latin American 2 - Intermediate Latin American 3 - Advance Latin American 4 - Masters (teacher and former winners)    Partner:

Dance with a stranger: (Choose Level) DWAS 1 - Beginner DWAS 2 - Intermediate DWAS 3 - Advance + Masters (2+ years)

Battle of the Sexes: Battle Of The Sexes Male pair Female pair Partner:

Modern Jive

Freestyle: (Choose Level) Modern Jive 1 - Beginner Modern Jive 2 - Intermediate Modern Jive 3 - Advance Modern Jive 4 - Masters (teacher and former winners) Partner:

Dance with a stranger: (Choose Level) DWAS 1 - Beginner DWAS 2 - Intermediate DWAS 3 - Advance + Masters (2+ years)

Battle of the Sexes: Battle Of The Sexes Male pair Female pair Partner:

Cabaret: NO YES Team: NO YES Numbers: 0 6 8 10 12

(any info to go with your cabaret team entry)

Waiver

Please read this waiver carefully. By submitting this application you agree to this waiver.

I understand that GDS may wish to record my participation in the competition on video, film or by photograph. If they do so, I give GDS the right to use any such recordings in any and all media, by whatever ways or means and with no obligation to me. Such recordings are the sole property of GDS. I understand that Dance is an athletic sporting activity and that GDS takes no responsibility whatsoever for any loss or injury to persons or possessions in relation to this competition. I have read the rules contained in this application and the above waiver, fully understand them and agree to comply with their contents.

Payment

Cost: $

Payment by: (Select) Cheque or money order direct deposit (email GDS for details) Pay cash at GDS class Pay with Paymate Express

Please NOTE:  Cheques or money orders should be made to Gaby’s Dance Studio Club - 15 Baracchi Cr, Giralang ACT 2617

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