REGISTRATION FORM
(print & mail - address below)
Please register by August 4/07 to reserve your spot!

Middle Eastern Drum & Dance
~ a women-only event ~
Sat., Aug. 11, 2007     2 - 4:30 p.m.

St. George's Anglican Church
1049 4th Ave. E., Owen Sound, ON

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

$35 pre-registered per person   _____ people @ $35 = TOTAL $___________

ADD $5 for drum rental for the event _______ drums @ $5.00 = TOTAL $______

                                                            TOTAL AMOUNT: $_____________
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Payment Method (please circle one):      Money Order        Cheque
Cheques payable to: Diana's Drum
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Disclaimer: I/we agree to indemnify and save harmless Zoë Kessler and Diana's Drum 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 Diana's Drum to:
Diana's Drum
R.R. 1, Bognor, ON N0H 1E0