REGISTRATION FORM "A Bride Made Ready" RETREAT - Burnsville, NC

Please print these 3 forms and fax or mail them to the information below. Not necessary if registering on line. They must be postmarked and/or received on or before March 15th, 2012 (for the very early savings rate) OR postmarked and/or received on or before June 3rd (for the early savings date); July 3rd, 2012 (for the regular rate). Anything postmarked, faxed, mailed, received after July 3rd, must pay the "at the door rate" (see above). Thank you.

To save on space, paper and to be able to read it more clearly, if you'd like, you may copy and paste all the information into a Word document, type in what's needed and then print that out to send in.

Name: ___________________________________

City/State:_________________________________

Phone #: ___________

E-mail (please print   very clearly):

______________________________________________

***This is very important. As the full registrations come in, we will be sending out informational letters. Also you may be interested in communicating with one another about room/ride sharing, etc. to help one another with expenses. Thank you for printing clearly!

Age (if under 18) ______________________________

Children under 12 are free. However EACH child under 12 must be accompanied by a fully registered, participating, responsible adult, who has authority to sign their waiver form. Due to the largely ministerial nature of the conference we ask that you consider the attention span of your child before registering them. There will be no sideline mothers for any youth (even non-dancing moms can enjoy themselves and receive ministry). Thank you.

Enclosed please find (please check mark all that apply):

_________$99 - Regular Rate - Received on or before July 3rd
_________Groups of 5 or more - $92.00 each**
_________Couples' Rate (husband and wife) - $90 each 

_________$114 - Door Rate - Received on or before July 20th

_________Groups of 5 or more - $107.00 each**
_________Couples' Rate (husband and wife) - $105 each**

________ Additional Love gift (helps offset conference expenses)

________ Total Thank-you, and may the blessings of God over take you!!!

PAYMENT METHOD - Please Circle One

MC VISA AMEX DISCOVER CHECK MO (US FUNDS ONLY)

CC# _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _
Please take extra room if you need to make it very clear to read

EXPIRATION DATE:____________________

(CSC# for AMEX/DISC only) _____________
That is that tiny 3 or 4 digit number on the card.

Signature:____________________________

Please make checks or money orders payable and mail to:

Dancing For Him
5337 N. Socrum Loop Rd. Suite 244
Lakeland, FL 33809  USA

Or fax forms (with credit card info) to: 863-583-7398

The amount of registrations, offerings, support, etc., is non-refundable. If for some unforeseen reason you will be unable to attend, your tax-deductible donation will be considered a love gift or scholarship to further the work of God through Dancing For Him Ministries. Thank-you for your generosity. NO one-day rates available. We encourage you to attend the entire retreat or as much of the retreat as you are able.

**To get the group rate if you are mailing or faxingin your registrations. We must have the entire group's money and paperwork in all together, at the same time. NOTE: In order to get the price of what ever cut off date you are attempting, ALL - ALL PAPERWORK must be in by that date, or you will need to pay the next cut off rate. In other words, if you make your payment by the early bird cut off date, but we don't receive your 3 forms by that cut off date, then you will need to pay the next rate up. PLEASE SEND IN YOUR PAPER WORK WITH OR IMMEDIATELY AFTER YOUR PAYMENT to avoid paying the higher rate. Your paperwork alone will not hold your space. Only when we receive both the payment AND your paper work will you be considered fully registered and your spot will be held. Thank you.

HOWEVER, TO REGISTER A GROUP ON LINE: Go to the Group Rate section of the bookstore and put in the appropriate number of orders for your group to pay all at once. Then write for which conference this is for in the comments section upon checkout. Make sure each person in your group agrees to the waiver, then print their names in the waiver agreement boxes at the bottom of the group registration page. If you have questions, please call: 863-398-8161 and I'll be happy to help you. If you have more than 5 names, please just print them in the comments box. Thanks!

WAIVER

WAIVER OF LIABILITY (ADULT-18YRS. OR OLDER)

Please fill in, sign and mail in with your registration.

OR if registering here on line, simply agree with your electronic signature in the box at the bottom of this page. When registering a group and putting a yes in the waiver drop down, that means that everyone in your group agrees.

PRINT NAME ________________________________

In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, here by for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Lynn Hayden, Wil Bozeman and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participation in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understand this waiver of liability, and agree to the same.

YOUR SIGNATURE: _______________________DATE: ____________
Program: Worship Dance Workshop Date(s) of Program: July 20-22, 2012

WAIVER OF LIABILITY -  CHILD (UNDER 18 YRS.)

PRINT CHILDS NAME:__________________________

In consideration of participation in this dance program and instruction, I the undersigned intending to be legally bound, hereby for myself and anyone acting on my behalf, release any and all claims for damages I may have against Dancing For Him Ministries, Inc., Lynn Hayden, Wil Bozeman and their sponsors, representatives, successors, and assigns for any and all injuries or death suffered by me in this program. I attest and verify that I know participating in this event can be a potentially hazardous activity. However, I have sufficiently prepared for this event and know that I am participating at my own risk. The waiver extends for the duration of the program. I also release DFH use of any video footage of me. I have read and understood this waiver of liability, and agree to the same.

SIGNATURE (Child): ____________________________ DATE: __________
Program: Worship Dance Workshop - Date(s) of Program: July 20-22, 2012
I am the parent and/or guardian of the aforementioned child. I consent to the waiver of liability on behalf of the child. I have read and understood this waiver of liability, and agree to the entire document intending to be legally bound thereby.

SIGNATURE (PARENT/GUARDIAN):  _______________
PRINT NAME (PARENT/GUARDIAN):_______________
DATE __________

OR if registering on line, simply put 'yes' in the child waiver agreement drop down list, at the bottom of this page, then put their name in the comments box after the credit card information, upon check out. 

CONCERT REGISTRATION FORM

Are you and/or your group participating in the Saturday evening concert? YES/NO

If yes, please continue and fill out this form. Mail or fax it in with your registration/payment/waiver. Please remember it is first come, first served . Only the first 12 dances that are fully registered will be able to participate. Once it is full, a notice will be posted here, just under the CONCERT REGISTRATION FORM heading. 

OR Just select “Yes” in the drop down list below and fill in the appropriate information in the comments box after entering your credit card information, upon check out. 

Individual Name ____________________

Name of Team Presenting: _______________________

Number of people in dance: ___________________

Name of Song to which you'll be dancing:____________________

Name of Artist

Length of Song: _____________________(please, under 6 minutes)

Type of dance (worship, praise, hip/hop, mime, etc.): __________________