8^th Regional HS Dance Festival

March 5-8, 2009

Norfolk, Virginia

Participant Form

$85 per Student

$40 per Chaperone/Faculty/Staff

Two Teachers included in Registration Fee

Check One: ______Teacher________Chaperone_______Student

Please use one form for each participant and remit appropriate fees

Participant Name____________________________________________

Home Address______________________________________________

__________________________________________________________

City_____________________State______________Zip ____________

Phone #__( _______)________________________ _______________

E-Mail Address____________________________________________

Affiliated High School_______________________________________

_________________________________________________________

Name of Teacher in Charge___________________________________

Parent/Guardian Signature____________________________________

Date_____________________________________________________

Check: Student Fee $85_________Faculty/chaperone $40__________

DEADLINE: January 23, 2009

MAKE CHECK PAYABLE TO GSA DANCE

School checks only, no personal checks will be accepted

Send completed forms to:

8^th Regional HS Dance Festival

The Governor's School for the Arts

C/O Old Dominion University

Norfolk, VA 23529-0556

dthorpe@gsarts.net