First Name:

Last Name:

Gender:

 Female         Male

Date of Birth: (date/month/year)

Address:

City:

State (US & CA):

Zip Code:

Country:

E-Mail Address:

Phone:

Cell/Mobile phone:

Contact Person Name:

(Mother, Father, Sister, Friend): (In case of an emergency)

Contact Person's Phone: 

(In case of an emergency)

Do you have a medical insurance for Europe?

Yes         No

My Dancing Experience

Please specify2-3 years3 - 5 yearsmore then 5 yearsprofessionall dancer

Presently Training At:

Any disability / medication? (If yes, please specify here)

Where did you hear about EDAS-CYPRUS workshops?

(please choose from the list, or write in the Remarks section.

Please choose oneFrom EDAS websiteFrom SIBA websiteReceived an e-mailFrom my chat websiteAd in a MagazineFrom my dance teacherI Searched the InternetFrom one of the workshop teachersOther

OPTIONAL ADDITIONS:

Single room supplement

(Euro 240 incl. breakfast

 Yes

No

Additional information or remarks: (also if you come with a chaperon, write here please)

*By submitting this form I agree to pay the registration/Processing fee of €200 upon registration, in order to secure my place. The balance to be paid on arrival.

* Online payments by credit card will be charged 3.5%.

* By submitting this form I agree to all terms and conditions specified above

I will pay the registration fee by:  Credit Card Online Bank transfer 

*You will receive an email confirmation with instructions how to pay

Enter the letters from the image blow in order to submit: