Application Form For Dance Without Limits*

EUR payment - USD payment

Name:
Surname:
Street:
Number:
City:
ZIP:
Date of Birth:
Phone:
E-mail:

Dancer:
Class:

1st week TBH	July 3ost - August 6th 2o11
2nd week TBH	August 6th - August 13th 2o11

Number of classes:
Faculty 1st week	Terry Beeman Naike Negretti Florence Meregalli
Faculty 2nd week	Derek Mitchell Naike Negretti Florence Meregalli

Level:
	intermediate advanced

Open card 1st week	all 6 classes per day (intermediate and advanced)
Open card 2nd week

Registration fee	400 Kč
Transport by bus from Prague	200 Kč
Total price	0 Kč
Notice:
Application is binding

* Notice: You will become the temporary member of o.s. Pop Balet. There is nothing binding for members in this membership. In case of correct payment the membership just allows the member to spend dance classes, accomodation and diets in particular range.