Dance Masters Of America, Inc. 133 rd National Convention Registration Form

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Dance Masters Of America, Inc. 133 rd National Convention Registration Form July 9 th - July 15 th 2017 (Suggested Arrival July 8 th - Departure July 16 th ) The New Orleans Marriott Hotel 555 Canal Street, New Orleans, Louisiana 70130 THIS FORM MUST BE FILLED OUT BY ALL TEACHER WHO ARE ATTENDING THE NATIONAL CONVENTION - INCLUDING THOSE USING DANCE COMP GENIE FOR PASC ENTRIES DEADLINE DATE FOR ALL PRE-REGISTRATION - APRIL 15th, 2017 NO EXCEPTIONS FOR LATE REGISTRATION ALL FEES MUST BE PAID BY THE TEACHER IN U.S. FUNDS, DRAWN ON A U.S. BANK THERE IS A 20% HANDLING FEE FOR ALL CANCELLATIONS OF CONVENTION FEES BEFORE JUNE 1 ST THERE IS 100% REFUND ON ALL BANQUET & COMPETITION TICKETS, SUPER SAVERS & PROGRAMS BEFORE JUNE 1 ST ALL REQUESTS FOR REFUNDS MUST BE MADE BY MEMBER TEACHER THERE ARE NO REFUNDS AFTER JUNE 1 ST ALL REGISTRATIONS WITH FULL PAYMENT MUST BE MAILED TO: DANCE MASTERS OF AMERICA, INC. CHARLEEN LOCASCIO - NATIONAL TREASURER 4621 REICH STREET - METAIRIE, LA 70006 - TELEPHONE: 504-454-1376 THIS FORM MUST BE FILLED IN ON LINE PRINTED AND SUBMITTED WITH FULL PAYMENT NAME OF STUDIO TEACHERS NAME HOME ADDRESS CITY STATE ZIP HOME TEL.: AREA CODE - WORK TEL.: AREA CODE - CELL TEL.: AREA CODE - E-MAIL: _ MEMBER-DMA CHAPTER # NON MEMBER I AM A FIRST TIME ATTENDEE In consideration of being accepted as participants in any and all activities and events of the 2017 Dance Masters of America s National Convention We (all parties registered on this form and all parents and guardians of minor children) do hereby release the Dance Masters of America, Inc., the Officers of the Organization, Faculty, Directors and Assistants of the Competition, the New Orleans Marriott Hotel, 555 Canal Street, New Orleans Louisiana 70130, from any and all claims for damages or injuries, which the entrant may sustain while participating in any activity connected with this Convention, Competitions and Events. We have also read the Official Rules of the 2017 Dance Masters of America, Inc. rules for all activities and do hereby agree to comply with said rules now in effect or as announced thereafter. In addition, we jointly give my permission as a participant and/or entrant to be photographed, video-taped or otherwise filmed and distributed during the 2017 National Convention. It is our understanding that the photographs, video tapes and all other devises used for recording will be used solely for and by the Dance Masters of America, Inc. at their discretion and in a manner benefiting the high standard of the association. It is further our understanding that these photographs and video tapes may be offered for sale at the discretion of Dance Masters of America, Inc. It is agreed and acknowledge that the Dance Masters of America's Solo Title Competitions are copyrighted events and that the use, distribution and/or syndication of any photographs taken and/or videotapes made by the professional photographer contracted by the Dance Masters of America, Inc., at any event and/or by others attending the event for other than personal use is specifically prohibited. Syndication on social media is strictly prohibited.

CLASSROOM 1 TEACHERS & DANCERS MINIMUM AGE 18 YEARS OF AGE Teachers Fees: Includes: Convention Classes, Video Privileges, Non-Transferable Banquet Ticket & Tee Shirt DMA Member Registration - Before April 15th $355.00/EA. After April 15th $405.00/EA $ Non Member Registration - Before April 15th $435.00/EA. After April 15th $485.00/EA $ Please type in the name and T-shirt size of all TEACHERS. C onvention badges and certificates will be printed from the information on this form. T-shirt sizes SM AD, MD AD, LG AD, or XL AD, XXL AD. SIZE SIZE Students Fees: Includes: Convention Classes And & Tee Shirt Please type in the name and T-shirt size of all SENIOR STUDENTS. Convention badges and certificates will be printed from the information on this form. T-shirt sizes SM AD, MD AD, LG AD, or XL AD, XXL AD. SIZE CLASSROOM 2 STUDENTS 13 17 YEARS OF AGE Non Member Registration - Before April 15th $310.00/EA. After April 15th $360.00/EA Please type in the name and T-shirt size of all TEEN STUDENTS. Convention badges and certificates will be printed from the information on this form. T-shirt sizes SM AD, MD AD, LG AD, or XL AD, XXL AD CLASSROOM 3 - STUDENTS - 10 12 YEARS OF AGE from the information on this form. T-shirt sizes SM CH, MD CH, LG CH, SA AD, MD AD, LG AD,

CLASSROOM 4 - STUDENTS 7 9 YEARS OF AGE from the information on this form. T-shirt sizes SM CH, MD CH, LG CH, SM AD, MD AD, LG AD, or XL AD, CLASSROOM 5 - DANCERS - 5 7 YEARS OF AGE Fee Includes: 3 Hrs of Classes on SUNDAY TUESDAY THURDSAY & SATURDAY & Tee Shirt DMA Member Registration - Before April 15th $150.00/EA. After April 15th $200.00/EA $ Non Member Registration - Before April 15th $170.00/EA. After April 15th $220.00/EA $ from the information on this form. T-shirt sizes SM CH, MD CH, LG CH, SM AD. CLASSROOM 6 - DANCERS - 4 YEAR OF AGE OR YOUNGER Fee Includes: 2 Hrs of Classes on MONDAY WEDNESDAY & FRIDAY & Tee Shirt DMA Member Registration - Before April 15th $70.00/EA. After April 15th $120.00/EA $ Non Member Registration - Before April 15th $90.00/EA. After April 15th $140.00/EA $ from the information on this form. T-shirt sizes SM CH, MD CH, LG CH, SM AD.

OBSERVER S FEES - FULL CONVENTION ONLY OBSERVERS ARE GRANTED ENTRANCE INTO SENIOR, TEEN, PRE-TEEN, JUNIOR, AND MINI DANCERS CLASSROOMS ONLY. OBSERVERS MUST BE A NON-DANCER, OVER THE AGE OF 18 AND REGISTERED BY A TEACHER OF RECORD. SORRY FIRE REGULATION DO NOT PERMIT BABY CARRIAGES IN THE CLASSROOMS. Observers (Full Convention) @ $40.00 each $ Please type in the name of all OBSERVERS. Convention badges will be printed from the information on this form. EXTRA BANQUET TICKETS IN ADVANCE Extra Banquet Tickets @ $65.00/EA. $ ADDITIONAL NATIONAL CONVENTION TEE SHIRT MUST BE PRE-ORDERED SM CH MD CH LG CH SM AD MD AD LG AD XL AD XXL AD COMPETITION SUPER SAVER PACKAGE TOTAL ORDERED @ $20.00/EA. Total $ Super Saver Package : TOTAL ORDERED @ $ 55.00/Ea. Total $ Super Saver Package includes 1 Ticket to each Solo Title Competitions, 1 Miss/Mr. Dance Program & 1 Solo Title Program Super Saver Package is only available with Pre-Registered - Not available on site. Tickets: Petite Miss/Master Scholarship Competition TOTAL ORDERED @ $10.00Ea. Total $ Junior Miss/Mr. Scholarship Competition TOTAL ORDERED @ $10.00Ea. Total $ Teen Miss/Mr. Scholarship Competition TOTAL ORDERED @ $10.00Ea. Total $ Miss.Mr. Dance Scholarship Competition TOTAL ORDERED @ $15.00Ea. Total $ Programs: Miss/Mr Dance Program Book TOTAL ORDERED @ $10.00/Ea. Total $ Solo Title Program Book TOTAL ORDERED @ $10.00/Ea. Total $ (Petite/Master Junior Miss/Junior Mr. Teen Miss. Teen Mr. Dance Scholarship Competitions) OPEN SCHOLARSHIP AUDITION REGISTRATION All students participating in the Open Scholarship Auditions must complete the OPEN SCHOLARSHIP APPLICATION AND SUBMIT IT NOT LATER THAN THE DAY PRECEDING THE AUDITION. (These Scholarship Auditions are not part of any Solo Title Scholarship Competition) ACROBATICS AUDITION: (JULY 9 TH 8:30AM) MODERN AUDITION : (JULY 9 TH 5:30PM) BALLET AUDITION: (JULY 10 TH 5:30PM)

JAZZ AUDITION: (JULY 11 TH 5:30PM) Before April 15th $35.00/Ea. After April 15th $45.00/Ea. TOTAL ENTRIES $ TAP AUDITION : (JULY 12 TH 5:30PM) NATIONAL CONVENTION TALLY SHEET Total Fees Paid For Teachers Convention Fees Total Fees Paid For 18 & Over Convention Fees Total Fees Paid For 13-17 Years of Age Convention Fees Total Fees Paid For 10-12 Years of Age Convention Fees Total Fees Paid For 7-9 Years of Age Convention Fees Total Fees Paid For 5-6 Years of Age Convention Fees Total Fees Paid For 4 & Under Convention Fees Total Fees Paid For Observers Total Fees Paid For Extra Banquet Tickets Total Fees Paid For Additional Convention T-Shirts Total Fees Paid For Super Savers Fee (Full Packages) Total Fees Paid For Petite Miss/Master Dance Tickets Total Fees Paid For Junior Miss/Mr. Dance Tickets Total Fees Paid For Teen Miss/Mr. Dance Tickets Total Fees Paid For Miss/Mr. Dance Tickets Total Fees Paid For Solo Title Program Book (Petite/Junior/Teen) Total Fees Paid For Miss/Mr. Dance Program Book Total Fees Paid For Acrobatic Scholarship Auditions Total Fees Paid For Modern Scholarship Auditions Total Fees Paid For Ballet Scholarship Auditions Total Fees Paid For Jazz Scholarship Auditions Total Fees Paid For Tap Scholarship Auditions Total Fees Paid For Preliminary PAC (Including Sur-Charges) Total Fees Paid For Final PAC (Including Sur-Charges) Note: (Contestants that do not qualify for final PAC Competition, refunds will be mailed after the Convention to the Teacher of Record.) GRAND TOTAL AND AMOUNT OF CHECK ENCLOSED FOR ALL REGISTRATIONS LISTED REMINDER! IF YOU OR ANY OF YOUR STUDENTS ARE ON SCHOLARSHIP TO THE NATIONAL CONVENTION THE SCHOLARSHIP FORM(S) MUST BE ENCLOSED WITH THIS CONVENTION REGISTRATION FORM