REGISTRATION FORM Beyond the Inner Court CONFERENCE - Wilmington, 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 December 1st, 2012 (for the EXTRA early savings date - in order to receive your free T-shirt). January 15th, 2013 (for the early savings date) OR postmarked and/or received on or before February 3rd, 2013 (for the regular rate). Anything postmarked, faxed, mailed, received after February 3rd, 2013, 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 pass along everyone's e-mail to everyone else, so you may communicate with one another about room/ride sharing, etc. This has been a wonderful way to get to know one another and to help one another with expenses. Thank you for printing clearly!
If you need more room to write, please feel free to write elsewhere on this sheet.
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. Thank you.
Enclosed please find (please check mark all that apply):
_______ Registration 84 (On or Before December 1st, 2012) Extra early savings date. Register on or before this date and receive a free DFH T-shirt (must attend and be present to receive). Please put your size in the drop down list upon checkout.
________ Group Rate $77**
________ Registration $84 (On or Before January 15, 2013)
________ Group rate $77**
________ Registration $99 (On or Before February 3, 2013)
________ Group rate $92**
________ Registration $114 (On or Before February 15, 2013)
________ Group rate $107**
________ 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, Suite 244
Lakeland, FL 33809 USA
Or fax forms (with credit card info) to: 1-863-583-7398
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 made into a love gift to further the work of God through Dancing For Him Ministries. Thank-you. NO one-day rates available. We encourage you to attend the entire conference or as much of the conference as you are able.
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 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: February 15-16, 2013
WAIVER OF LIABILITY - CHILD (UNDER 18 YRS.)
PRINT CHILDS NAME:_____________________________________
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.
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 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: February 15-16, 2013
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 __________
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 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.): __________________