(Fill in one form per person, then SUBMIT or print, sign and post or hand in to us with your payment)
Name:
Address: Post Code:
Email: Phone: Mobile:
Ticket type: (Select ticket type required) Competition and Ball $125 Ball Only (& Competition Spectator) $90 Spectator Only (Competition) $20 Spectator Student/Senior (Competition) - FREE (Choose your Ball Meal) Vegetarian Carnivore
Comp and Ball DVD: (Select Comp and Ball DVD required) Yes DVD for Competitor $25 Yes DVD for Non Competitor $35 No DVD $0
Video Camera Licence: (Select your Video Camera Licence) Yes Video Camera Licence $20 No Video Camera Licence $0
Please complete the below form for the events you would like to compete in
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 Male pair Female pair Partner:
Freestyle: (Choose Level) Street Latin 1 - Beginner Street Latin 2 - Intermediate Street Latin 3 - Advance Street Latin 4 - Masters (teacher and former winners) Partner:
Freestyle: (Choose Level) Ballroom Latin 1 - Beginner Ballroom Latin 2 - Intermediate Ballroom Latin 3 - Advance Ballroom Latin 4 - Masters (teacher and former winners) Partner:
Freestyle: (Choose Level) Modern Jive 1 - Beginner Modern Jive 2 - Intermediate Modern Jive 3 - Advance Modern Jive 4 - Masters (teacher and former winners) Partner:
Cabaret: NO YES Team: NO YES Numbers: 0 6 8 10 12
(any info to go with your cabaret team entry)
Please read this waiver carefully. No application will be accepted without the signature of all competitors.
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.
Cost: $
Payment by: (Select) Cheque or money order direct deposit (Add your name in the reference field) Pay cash at GDS class
Please NOTE: Cheques or money orders should be made to Gaby’s Dance Studio Club - P.O. Box 464 Kippax ACT 2615
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Signature: Date:
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