NIA Drum & Dance Workshop

Sat., June 21, 2008    2 - 4:00 p.m.
Durham Town Hall, 185 George Street W.
(1 blk. N. of Grey Road 4; West off Hwy. 6)
Durham, ON

Registration Form
~ Please print & mail (address below) to reserve your spot!

Name :……………………………………………………………
Address:………………………………………………………………………
City:………………………...……Postal Code:..……….........
Telephone:…………………………………e-mail:…..………………………
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Payment Information:

$35 per person (inc. drum rental or bring your own drum)

 _____ people @ $35 = TOTAL $___________

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Payment Method (please circle one):      Money Order        Cheque
Cheques payable to: Zoë Kessler
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Disclaimer: I/we agree to indemnify and save harmless Zoë Kessler, Diana's Drum and Vita Wind from any actions or claims brought against it as a result of attending this workshop. The hand drumming instructor will not be held responsible for personal injury, damage or for the loss or theft of personal belongings, instruments or other items brought to the class. It is understood that in the event of extreme weather conditions or other unforeseeable circumstances, this workshop may be cancelled and re-scheduled at the discretion of the facilitator(s).

Signature: …………………………….. Date:…………………..

Signature: …………………………….. Date:…………………..

Signature: …………………………….. Date:…………………..

Please send registration form and cheque/money order payable to Zoë Kessler to:
Diana's Drum
1101 3rd Avenue E., Owen Sound, ON N4K 2L3