Please provide the following  information: (Use Tab to move between fields)

Are you a current client with DMI?	Yes        No
Select Competition	Lakeland FL Mobile Al New Orleans LA Panama City FL Dallas TX Myrtle Beach SC                                                                               Competitions
Studio/School Name	Lakeland Dance Challenge-Lakeland, FL Jan 16, 2010
Director's Name	Curtain Call Dance Challenge-Regionals Mobile, AL Feb 6
Address	The Big Easy Dance Event and Convention- New Orleans, LA Mar 27,28
City	Sun City Dance Fest-Nationals -Panama City,  Apr 17,18
State	Mississippi Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip Code                       Dallas, Tx Area TBD 2010
Email Address	Myrtle Beach, SC Area TBD 2010
Home Phone
Cell Phone
Studio Phone	Fax Number
Name of Routine/Music Title
Performers                                      (mm/dd/yyyy     *Age is as of the date of the competition )
Name                                          Date of Birth   Age         Name                                          Date of Birth   Age
1                26
2                27
3                28
4                29
5                30
6                31
7                32
8                33
9                34
10              35
11              36
12              37
13              38
14              39
15              40
16              41
17              42
18              43
19              44
20              45
21              46
22              47
23              48
24              49
25              50
Age Division  None 0-4 5-6 7-9 10-12 13-14 15-16 17-18 19-90 Teacher
Categories  Ballet Musical Theatre Acrobatics One Baton Dance Twirl Multiple Baton Freestyle Baton Jazz Dance Twirl Freestyle Baton Folklore Gymnastics Song & Dance Clogging Lyrical Contemporary PomPon HipHop Prop/Novelty High Kick Flag Rifle Open Tap
Group Size Duet_Trio Small Group 4-9 Large Group 10-18 Line 19 or more
Duet/Trio Fee	$95.00
Best Costume	$25.00
Group Entries (fee is for each group entry per individual)	$30.00 per person X no of performers   =
Entry Fee Total
Payment Type	Money Order/Cashiers Check Visa Mastercard
Any dancer competing in a dance competition takes certain inherent risks.  These include, but are not limited to, sprains, bruises, pulled muscles and broken bones.  Participation in this competition indicates the acceptance of such risks.  Therefore, the above signed guardians hereby release and will not hold DANCE MAGIC Inc, its directors, officers or staff liable or responsible for injuries or damages sustained while participating in any activity related to DANCE MAGIC Inc. Competitions/Convention. All studio owners, directors, teachers and choreographers do hereby grant permission for DANCE MAGIC Inc to use their choreography, photos, electronic/video images and/or likeness for appearance on video, television or any advertisement of our events without any form of compensation.   I accept the waiver and release terms on behalf of my performers and will forward a completed and signed copy to Dance Magic before competition begins.   (Click the above checkbox to accept rules. Click the Recalculate button to compute total. Click Submit form.)