JUAN SIDDI FLAMENCO DANCE WORKSHOP
Friday, Saturday, Sunday, November 27, 28, 29, 2009

Non-refundable $60.00 deposit for each full 3-day session due November 14, balance on registration. Drop-in fees payable at door.

Make checks payable to VIVIANA & send to 

PFB / VIVIANA
4620 SW Beaverton-Hillsdale Highway
Portland, OR 97221

........................................................ Print & Mail Coupon: .............................................................

Enclosed is my check/money order for $___________ made out to VIVIANA.

(   ) I wish to attend LEVEL 1 SESSION Nov. 27, 28, 29 @ $100.00
(   ) I wish to attend this level only on: (   ) Nov. 27  (   ) Nov. 28  (   ) Nov. 29 @ $38.00 per class

(   ) I wish to attend LEVEL 2 SESSION Nov. 27, 28, 29 @ $100.00
(   ) I wish to attend this level only on: (   ) Nov. 27  (   ) Nov. 28  (   ) Nov. 29 @ $38.00 per class

(   ) I wish to attend BOTH SESSIONS @ $170.00

(  ) My non-refundable deposit of $_____________________ is enclosed

Student's Name_________________________________________________________

Address_______________________________________________City______________

State________Zip________   Email___________________________________________

Tel:  Days___________________________Eves________________________________