2009 LHDA Entry Form

Please print - All information must be complete

Dancer's Name:
Address:
 
Postal Code:    Phone:   
Age as of May 9, 2009:   Birth Date (D/M/Y):  
E-mail:  
SOBHD #     Local Dance Association #:  
Dance Teacher:    

Please check the appropriate dances:
Event/Dance Prim A Prim B Beg Nov Int Prem
Fling          
Sword 2&1    
Pas de Basque    
Pas de B.&
High Cuts		    
Seann Truibhas      
Lilt    
Flora    
Johnnie    
Laddie    
Hornpipe    

Premier 16 & Over: Cash ______ OR Medal ______
Entries not properly filled out will be notified and will not be accepted unless returned before the closing date.

FEES:     
Class# of dancesFee                       
Primary x $4.00   
Beginner x $5.00   
Novice x $5.00   
Intermediate x $5.00   
Premier x $5.00   
SDCCS and
AHDA fees		  $2.00 
Number fee(Refunded with
number return)		 $1.00 
Late entry fee     
TOTAL     

Please make cheque or money order payable to LHDA.

Mail completed entry page and fees to:

Karen Olsen
90 Salish Place West
Lethbridge, AB
T1K 7X1

In consideration of your accepting this entry, I hereby for myself, my heirs, executors and administrators waive and release any and all rights and claims for damages I may have against the Lethbridge Highland Dance Association, its agents, representatives, successors and assignees, for any and all injuries or illnesses suffered by me at or through the above mentioned competition.

SIGNATURE: _____________________________________________
(This must be signed by a parent or guardian if the competitor is under 18 years of age.)

If you were a perpetual trophy winner in 2008 please indicate when you will be returning the trophy.

AM ____ PM ___

1