BELLY DANCE IN STYLE WORKSHOP REGISTRATION FORM

Ever wonder what the difference is between the belly dance styles? Do you want to be able to recognize the different performance styles? Do you want to learn more belly dance technique skills for these different styles?

Revive Wellness Center Studio Saturday June 21^st

12-6 pm workshop 8-10 pm performance

Name__________________________________________

Address________________________________________

__________________________________________

City State zip code

Phone number___________________________________

Email address___________________________________

Registration for:

Workshop and performance $115 ($95 if registered by June 1^st)____________

Workshop 12-6 only $105 ($85 if registered by June 1^st) ____________

Performance night only 8- 10 pm $10 _______________

Total Amount paid: ______________

Credit card number ( Visa/MC only) _________________________

Exp. Date _____________ zip code __________________________

Signature ______________________________________________

Checks and cash also accepted. Checks payable to “Revive Wellness Center”

FAX form to : Revive Wellness Center 203-387-8151 or

Mail to: Revive Wellness Center

867 Whalley Avenue

New Haven, CT 06515

Phone number 203-387-1540 www.revivewellnesscenter.com

No refunds or exchanges.