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The 1st Annual CHICAGO TAP SUMMIT – Registration Form
Location: South Shore Cultural Center – 7059 S. Shore Drive
NAME:__________________________________________AGE:_______PHONE:_____________________
ADDRESS:______________________________________________________________________________
CITY:__________STATE:_______COUNTRY:_________ZIP:__________EMAIL:______________________
STUDIO:_________________________HOW DID YOU HEAR ABOUT US?:__________________________
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PLEASE CHECK OFF DESIRED CLASSES BELOW
Friday, Oct 7th
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Time |
Studio A |
Studio B |
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4:00-5:15 |
□ Int – Lee |
□ Adv – Dormeshia |
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5:30-6:45 |
□ Int – Jumaane |
□ Adv – Derrick |
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7:00-8:15 |
□ Int – Bril |
□ Adv – Robert |
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8:30-9:30 |
□ PANEL DISCUSSION - Robert |
Sunday, Oct 9th
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Time |
Studio A |
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11:00-12:00 |
□ Youth - Lisa |
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12:00-1:00 |
□ Adult Beginner - Bril
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Saturday, Oct 8th
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Time |
Studio A |
Studio B |
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11:00-12:15 |
□ Int – Star |
□ Adv – Tre |
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12:30-1:45 |
□ Int – Dormeshia |
□ Adv – Lisa |
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2:00-3:15 |
□ Int – Derrick |
□ OpenHistory-Robert |
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3:15-4:15 |
LUNCH BREAK |
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4:15-5:30 |
□ Int – Robert |
□ Adv – Dormeshia |
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5:45-7:00 |
□ Int – Jaybo/Nico |
□ Adv - Derrick |
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7:30-9:00 |
□ TAP JAM/SHOWCASE |
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PLEASE CHECK OFF PAYMENT SELECTION(S)
*** TAKE OFF 10% FOR ALL REGISTRATIONS MAILED BY SEPT 23rd
All quoted prices are in US Dollars
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□ Grand Slam Int. or Adv. Summit Package - $200.00
Includes 8 int. or adv. classes, panel discussion, tap jam, and 1 Concert Ticket
□ Four Class Int. or Adv. Summit Package - $110.00
Includes 4 int. or adv. classes, panel discussion, tap jam, and 1 Concert Ticket
□ Individual Int., Adv. Summit Class Rate- $25.00
# of classes ___ x $25 = _____
Does not include entrance to other summit events
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□ Youth or Adult Beginner Class - $20.00
□ Panel Discussion - $5
□ Tap Jam/Showcase ticket - $10
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□ I would like to reserve tickets for "UNSPOKEN WORD" – Sunday Oct 9th
4:00pm
# of Tickets ___ x $15 = _____
TOTAL AMOUNT ENCLOSED: $_____
I would like to receive my registration/payment conformation □ by phone, or □ by email
Payments can be made via cash, check or money order
Please make payments payable to:
M.A.D.D. Rhythms
7059 S. Shore Drive Ph: (773) 604-1899
Chicago, IL. tapsummit@maddrhythms.com
60649 www.maddrhythms.com
Rules, Regulations and waiver:
1) M.A.D.D. Rhythms Inc. reserves the right to refuse admittance to anyone of disruptive and unruly nature at the discretion of artistic director. 2) M.A.D.D. Rhythms Inc., alongside participating instructors will not be held responsible for any claims to damages or injuries of any kind resulting from activities listed in these classes. 3) M.A.D.D. Rhythms Inc. reserves the right to use their photos and videos for advertising and publicity purposes. 4) Individual video taping is prohibited. 5) No refunds given unless for medical reasons of which documentation is required. I hereby acknowledge the above stated rules and regulations and accept and assume all risks, damages or injuries of any kind. In signing this agreement, I am aware of all contained information and that I am affecting my legal rights.
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DATE
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SIGNATURE OF PARTICIPANT OR PARENT/GUARDIAN IF UNDER 18
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