Kcdc - registration form

Please find the registration form of the kibbutz contemporary dance company's activities.
Please choose the desired path and fill up the details. Good luck

  MASA Dance Journey program
  London Audition - Saturday, December 3, 2011
   Berlin Audition - Sunday, December 4, 2011
   SAN FRANCISCO INTENSIVE WORKSHOP December 12-14, 2011
   LOS ANGELES INTENSIVE WORKSHOP December 19-24, 2011

Personal details

Surname:	Name:	Gender:
Cell / Mobile Phone:	Home Phone:	Date of Birth: (dd/MM/yyyy)
Contact person name:(Mother, Father, Sister, Friend) (In case of emergency)		Contact Person's Phone:
Health Insurance:	Passport number:	Nationality:

Address

Street:		House number:		City:
State:		Zip Code:		Country:

E-Mail Address:

Dancing experience

Presently training at:
Past Experience:
Any disability?: (If yes, please specify here)

General

Size of your T-shirt:
Vegetarian:
Where did you hear about the Workshops/program?:

MASA Dance Journey program

Dates you would like to participate:
Where did you hear about MASA Dance Journey program?

Additional instructions will be sent to you, enabling to continue the registration.