SOUTH EAST BELLY DANCE QUEEN COMPETITION

Registration for which classification?

Queen soloist

Princess soloist

Dance Troupe

Registration for which classification?     Please mark one:

Name:

Stage Name:_________________

Address:

Cell Phone:

Alternative Phone:

Email address:

Please PRINT:

Date of Birth:

Age: ______

Years of study:

Training information:

Please list all the instructors you have learned under

Length of training:

Place of training:

* Please enclose a 5x7 picture of yourself or email to: irenerimer@yahoo.com

** If competing under the "Dance Troupe" category, you must fill a form for each of the contestants