| SalsaBoston.com |
| 3rd Annual New
England Salsa Competition, 2003 |
| Registration Form |
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Leader |
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Follower |
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Full Name |
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Name you wish to be called |
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Address |
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City/State/Zip |
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Telephone |
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(
)________________________ |
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(
)________________________ |
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Email |
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Age |
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Yrs. Dancing |
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Yrs Dancing Salsa |
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| Have you
ever earned money teaching or performing Salsa or similar Latin dance? |
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(circle one) YES NO |
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(circle one) YES NO |
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if both NO,
then you may compete in amateur |
| If you do
not live in New England (MA, CT, RI, VT, NH, MA), please list some of the
places you have danced: |
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Name of club/school |
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Location |
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# times in last year |
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| I, the
undersigned, hereby agree to the following terms: |
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I will abide by the
contest rules and to follow the instructions of the competition committee. |
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I recognize that
competitive dancing may result in accidental injury and I am participating at
my own free will, expense, and risk. |
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I hold
SalsaBoston.com, the host venue, the competition committee, and any agents of
these harmless of any liability that may result from my participation. |
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I agree to assume all
responsibility for any fees or taxes that may result of winning any prizes. |
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I grant
SalsaBoston.com and the competition committee the right to use my name and
any photographs or video for any purpose without compensation. |
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I certify that the
information given above is correct. |
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Signature |
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Print Name |
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Date |
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Date |
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Complete and submit to: |
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Olaf Bleck |
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SalsaBoston.com |
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24 Breakwater Dr. |
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Chelsea, MA 02150 |
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Note: submission prior to
a preliminary round will insure your VIP admission to the venue. |
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For questions contact Olaf Bleck,
617-513-9841, olaf@salsaboston.com |
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