REGISTRATION FORM

Workshops with

Adrian Veredice & Alejandra Hober ( Dublin, 30-31 August 2008)

Personal Details

Name:................................. Phone 1: …………….......................

Surname:............................. Phone 2:...........................................

Leader/Follower:…………… Email:............................................

Country:............................................

Level:

- Level (Beginners/Intermediate/Advanced): ……………………….....

- Dancing experience (months/years): …………………………

Partner:

-Name of Partner…………………… -Please find partner for me □

Classes chosen (please indicate):

 a) Saturday 30 August 12.00-1.30pm  d) Sunday 31 August 1-2.30pm

 b) Saturday 30 August 1.45-3.15pm  e) Sunday 31 August 2.45-4.15pm

 c) Saturday 30 August 3.30-5pm  f) Sunday 31 August 4.30-6pm

Total number of classes chosen:.........................

Payment details (please indicate)

 a) Cash payment

 b) Payment made to the following account (please use description ´tango festival´):

Account Name: Zaino

Bank: Allied Irish Bank NSC: 93-10-63

Account Number: 32256315

IBAN: IE83 AIBK 6332 2563 15 BIC: AIBKIE2D

Total amount paid: ………………………

*********** Please enclose proof of payment ************

Signed Date