Danzantes Unidos 2005

OOOOOOOOOO

Ballet Folklórico Mexicano de Carlos Moreno

And

Chicano Latino Education Association of Chabot College

At

Chabot College 25555 Hesperian Blvd. Hayward, California, 94545

Registration Form

Early Registration Postmark by March 18, 2005 ............................... $35.00 Regular Registration Postmark between March 19 and April 1, 2005 ........... $45.00 Registration by Waiting-List or on-site between April 2 and April 8 ........... $50.00 [Payments received after April 2, by CASH or MONEY ORDER only]

Registration includes: Friday Festival Concert, Friday Night DJ Pachanga and the Sunday Festival Concert.

Registration fee does NOT include meals, nor the Saturday Night Gala Concert.

EVENT Registration (see above) Pachanga DJ Dance and Friday Night Festival Concert $10.00 (non-registrants) Saturday Gala Concert $15.00 Sunday Festival Concert $10.00 (Non-Registrants)

QUANTITY # of Registrants __________ # of Cassettes ____________   # of Tickets _____________ # of Tickets _____________

AMOUNT $ _______________ $ _______________   $ _______________ $ _______________ Total Amount $_______________

Group (plese fill in completely)

Name of Group: __________________________________________________________________________________

Director's Name: ________________________________________ Phone: Phone:____________________________________

Fax: ______________________________ E-mail: ___________________________

Address: __________________________________________________________________

City and Zip __________________________________________________________________

Alternate Contact Person: ____________________________________________________ Phone: ___

Business Card supplied: _Yes _No

Your Group's Name ___________________________________________

Workshops to be offered

Azteca / Baja California Norte / Chiapas / Chihuahua / Durango Jalisco / Michoacán / Sinaloa / Tamaulipas / Veracruz / Yucatán

Participant(s)

1. Name: ____________________________________________ Age: ______

Address: __________________________________________

City: _____________________________________________

Level (circle one) Beg. Int. Adv.

Region requested - 1st. ______________________________ 
                   2nd._______________________________

Signature of Parent or Guardian if under 18: ___________________________________

2. Name: ____________________________________________ Age: ______

Address: __________________________________________

City: _____________________________________________

Level (circle one) Beg. Int. Adv.

Region requested - 1st. ______________________________ 
                   2nd._______________________________

Signature of Parent or Guardian if under 18: ___________________________________

3. Name: ____________________________________________ Age: ______

Address: __________________________________________

City: _____________________________________________

Level (circle one) Beg. Int. Adv.

Region requested - 1st. ______________________________ 
                   2nd._______________________________

Signature of Parent or Guardian if under 18: ___________________________________

4. Name: ____________________________________________ Age: ______

Address: __________________________________________

City: _____________________________________________

Level (circle one) Beg. Int. Adv.

Region requested - 1st. ______________________________ 
                   2nd._______________________________

Signature of Parent or Guardian if under 18: ___________________________________

5. Name: ____________________________________________ Age: ______

Address: __________________________________________

City: _____________________________________________

Level (circle one) Beg. Int. Adv.

Region requested - 1st. ______________________________ 
                   2nd._______________________________

Signature of Parent or Guardian if under 18: ___________________________________

(Please, copy and staple this form if you need more space for more participants)

If you have any questions, please call

510.562.6046, bfmexicano@aol.com -or-

510.732.2746, machetez@sbcglobal.net, www.zermeno.com

$35 per Early Registrant Mail Registration Form to: Danzantes Unidos '05 57 Marlow Dr. Oakland, CA 94605 Check payable to: Danzantes Unidos '05

For Official use Only Date Rec'd: ___________________________________ Date Approved: ________________________________ Amount: ______________________________________ Check # ______________________________________ Other: _______________________________________

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