Registration form

NOTE – DFTC 2015 registration deadline May 1st, 2015

Copy and Paste registration form below to word document & mail to:
DFTC 2015
c/o Grace Salez
107 – 640 Dallas Road
Victoria, BC V8V 1B6
Canada
_____________________________________________________________________________________

DFTC 2015 REGISTRATION FORM:
REGISTRATION FEE: $1,000.00 CANADIAN
Payable by cheque, draft, or money order to ‘DFTC 2015’
Include payment & CV with registration form to address above

PARTICIPANT’S NAME:__________________________________________________________________

CHOREOGRAPHER [___] DANCER [___] FILMMAKER [___] DOCUMENTARIAN [___]
VISUAL ARTIST [___] PERFORMANCE ARTIST [___] OTHER [___]

ADDRESS:_____________________________________________________________________________

HOME PHONE:________________________CELL PHONE:_______________________________________

EMAIL ADDRESS:_______________________________________________________________________

WILL YOU BE BRINGING YOUR OWN VIDEO CAMERA [____]YES [___]NO
WILL YOU BE BRINGING YOUR OWN LAPTOP WITH EDITING PROGRAM [___]YES [___]NO
*We have production equipment but you may use your own equipment

Permission to publish your name & email address (check box if you agree):
[___] I grant DFTC 2015 permission to publish my name and email address on a list for all
workshop participants.

YOUR SIGNATURE________________________________DATE_______________________________



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