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2018 Belly Dance Competition USA™

REGISTRATION FORM

Name____________________Dance Name_________________Years Exp.____
Address______________________Teacher__________________Date________
City___________________State_______Zip________Phone_______________
Category(ies)________________________________Vendor_______________

Email Address_______________________________
Category Fee(s) Enclosed_____________

Vending Fee Enclosed_______ (Check for availability)
Total Enclosed:______________

Credit Card____________________________Exp. Date___________CSV#_______

Zip code of card billing address__________________

I authorize Jareeda, Mezdulene, Mystical Oasis, The Belly Dancer U.S.A. Competition(TM) entities, Associates and/or heirs to use or sell any or all photos or videotapes taken during said competition, for educational, promotional and professional purposes. Any competitor winning any category of The Belly Dancer U.S.A. Competition(TM) agrees to use the title of that category correctly for publicity purposes. Competitors assume all responsibility and liability for themselves and all personal property. All applications, forms, contracts, releases, moneys, etc. must be signed by competitor and received by The Belly Dancer U.S.A. Competition or its staff, before being accepted into any category in the Competition. If I am crowned winner of The Belly Dancer U.S.A. Competition(TM) category, I agree to return the following year to perform in the evening show and present that year's winner his/her crown. I agree to abide by all "Rules of The Belly Dancer U.S.A. Competition(TM). I agree to the above, and I do hereby release Jareeda, Mezdulene, Mystical Oasis, The Belly Dancer U.S.A. Competition(TM) and anyone working with or connected to the Belly Dancer U.S.A. Competition(TM) ) from any claims for any kind of damages, loss, theft or injuries incurred while participating in this competition.

Signature and date.___________________________

Mail to Jareeda, P.O. Box 680, Sutherlin, OR 97479

 

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