2009 Registration Form

2009 Registration Form

An annual $15.00 membership fee is required from each Lotus Member. This fee covers enrollment from the date of purchase until the end of that year. Upon payment, you will receive a LOTUS Music & Dance Member I.D. card. Please keep the card available. You may pay by cash, check or credit card. *Please make checks payable to LOTUS Music & Dance. PLEASE PRINT CLEARLY

Today’s Date______Name ______Address______City______State______Zip______Phone (Home) ______

(Work) ______(Cell) ______Email:______

How did you hear about Lotus? ¨ Friend (word of mouth) ¨ Internet (Lotus website) ¨ Internet (Other
Websites: ______) ¨ Received flyer/calendar by email or mail ¨Other: ______

¨ I would like to receive the Lotus Music & Dance E-Newsletter!

I am interested in the following types of events:

¨Burmese Dance & Music ¨Middle Eastern Dance & Music ¨Butoh ¨Native American Dance & Music ¨Flamenco ¨Classical Indian Dance & Music ¨W. African Dance & Music ¨Bollywood/Bhangra ¨Hula/Tahitian ¨Korean Dance & Music ¨Indonesian Dance & Music ¨Bulgarian Dance & Music ¨Yoga/Qiqong/Other Wellness Programs ¨Cooking ¨Children's Classes & Workshops

¨Drums Along the Hudson: A Native American Festival ¨Performances/Special Events ONLY (I do not wish to receive class & workshop announcements) ¨All

¨ Please send me emails regarding volunteer opportunities at Lotus Music & Dance.
¨ Please send me emails regarding studio rental updates/discounts at Lotus Music & Dance.
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Waiver and Release

I hereby waive all claims for injury, damage or loss to my person and property during participation in classes conducted at Lotus Fine Arts Productions Inc. (Lotus Music & Dance) and release the promoters, directors, principals and employees of Lotus Fine Arts Productions Inc. from any liability for injury, damage or loss which may be caused by any act or omission by any of them.

Student’s Name (Print) Student’s Signature Signature of Parent or Guardian if under 18

______

Membership Fee: $ 15 Class for Member: $ 14 for 1 Hr, $ 16 for 1.5 Hr Non-Member: $ 19 for 1 Hr, $ 21 for 1.5

Observation for any Classes: $ 5 for 1 Hr, $ 7 for 1.5 Hr

For LOTUS use only:

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