City, State: Zip: Province, Country (For international students): Phone: Email: ... Pay Online via PayPal*: Use your Ame
2015 SUMMER INTENSIVE REGISTRATION FORM Name: Address:
Age: City, State:
Zip:
Province, Country (For international students): Phone:
Email:
Students must register for the entire week. There is no registration for individual classes. Students who register for Session II must participate in the morning session beforehand. Please indicate which Session(s) you are registering for with an “x”: WEEK I: July 6th-July 10th, 2015 _____ Session I: 10:00am-1:00pm Total: $190.00 _____ Session I & II: 10:00am-1:00pm & 2:00pm-5:00pm
Total: $380.00
WEEK I: July 13th-July 17th, 2015 _____ Session I: 10:00am-1:00pm Total: $190.00 _____ Session I & II: 10:00am-1:00pm & 2:00pm-5:00pm
Total: $380.00
Registration forms and payment must be received before students will be permitted to take class. Pay by Check: Enclosed is a check in the amount of $ made payable to Trisha Brown Company, Inc. Please send Registration Form & check to the following address: Trisha Brown Dance Company c/o Martita Abril, Education Associate 341 W 38th Street, Suite 801 New York, NY 10018 Pay Online via PayPal*: Use your American Express, Discover, MasterCard or Visa to pay online at the Trisha Brown Company website Email signed registration forms to
[email protected]. *Please add a processing charge: $6 per session for domestic credit cards and $10 per session for international cards.
2015 SUMMER INTENSIVE REGISTRATION FORM (continued) Liability and Photo Release Waiver: 1- By registering to participate in the Trisha Brown Dance Company (TBDC) Summer Intensive, I hereby waive, release and forever discharge TBDC and its officers, directors, agents, insurers, and employees from liability from any and all claims, actions, and causes of action (including resulting from negligence) that may at any time result from my participation in the Intensive, including any such that relate to costs, expenses or damages to my personal property, personal injury or illness (including death). 2- I confirm that I am in good health and physically fit to participate in the Intensive. I assume all risks of any damage, injury or disability to my person or property that may occur as a result of my participation in the Intensive and acknowledge that I will be solely responsible for any and all costs and expenses that I may suffer as a result of my participation in the Intensive. I hereby give up any right that I might otherwise have to sue for injury or damages resulting from my participation in the Intensive. 3- I grant TBDC employees and representatives the right to take photographs of me and to use my likeness in photographs or video taken at the Intensive. I authorize TBDC to use and publish these photographs with or without credit. I waive any right to compensation arising or related to the use of these photographs. By signing below I confirm that I have read and accepted the condition to my participation in the Intensive as set forth above. Applicant Agrees (signature required): _____________________________Date: _______________ Refunds: Requests to withdraw registration must be received by June 22nd, 2015 in order to receive a full refund (minus the administrative fee). Refunds or credits will not be given after the first day of classes. There will be no exceptions to this policy, although extenuating circumstances due to medical or family emergencies will be reviewed on a case by case basis. All refund requests must be submitted in writing. Payment will be returned if your selected class is fully booked. For additional questions, please visit our website www.trishbrowncompany.org or email
[email protected].
