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Return
All Forms and Files Page | | | | | |
| | SOLO Registration Form | |
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Printable Web Pages | Two ( 2 ) Pages: 1.
SOLO Registration Form | 2.
Release Agreement | |
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Please, FAX the Registration Form to one of the FAX numbers: | |
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TOKYO: +81-3-4496-4764 ▪ NEW YORK: +1-212-504-3246 ▪ VIENNA: +43-1-253-03330017 | |
| | BALLET PRODIGY, 590 Madison Avenue, 21st Floor, New York, NY 10022 USA
E-mail: admin@ibsbp.org ▪ Website: www.ibsbp.org ▪ Telephone: +1-212-504-3246 ▪ Fax: +1-212-504-3246 | |
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| | DANCER: | |
| | First Name | Middle Name | Last Name | |
| | Date of Birth: | Day | Month | Year | Female: □ | Male: □ | |
| | Ballet School Name | |
| | Director: First Name | Middle Name | Last Name | |
| | Ballet Teacher | Ballet Coach | |
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| | BALLET SCHOOL CONTACT INFORMATION: | |
| | Address | |
| | City | State/Region | |
| | Zip/Postal Code | Country | |
| | Telephone: | Fax: | Mobile: | |
| | E-mail: | Website: | |
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| | DANCER CONTACT INFORMATION: | |
| | Address | |
| | City | State/Region | |
| | Zip/Postal Code | Country | |
| | Telephone: | Fax: | Mobile: | |
| | E-mail: | |
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| | BALLET ENTRY INFORMATION: | |
| | Title: Classical Variation 1 | |
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| | Title: Classical Variation 2 | |
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| | PARTICIPATION FEE: USD $175 — ALL INCLUSIVE — Includes All Communication, Processing and Participation Costs. Non-Refundable. | |
| | * Payment Method — International — Bank Wire Transfer — Bank Wire Transfer Information: | |
| | Swift Code: WFBIUS6S | Bank Name:
Wells Fargo | Bank Account: ABA #: 121000248 Account #:
2000059162476 | | |
| | Bank Account Holder: International Ballet Society | Bank Account Address: 590 Madison Avenue, 21st Floor, New York, NY 10022 USA | | |
| | Bank Branch Address:
420 Montgomery Street, San Francisco, CA 94104 | For: Registration | | |
| | * Payment Method — USA Only — Check on USA Bank or Money Order: | Payable to: International Ballet Society | | |
| | Mail to: BALLET PRODIGY, 590 Madison Avenue, 21st Floor, New York, NY 10022 | Telephone: +1-212-504-3246 | | |
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| | Please, FAX a signed copy of the attached Release Agreement with the Registration Form. | |
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| | Signature: Ballet School Director or Parent/Guardian | Date | |
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Please, Continue to the
Release Agreement
Page → | | | | | |
