JAZZ TAP ENSEMBLE 25th ANNIVERSARY HOLIDAY WORKSHOP LA DEC. 26-30, 2003
REGISTRATION FORM - PLEASE PRINT
Name___________________________________________________________________________ Address_________________________________________________________________________ City________________________________State_____ZipCode___________Country___________
Phone (H)_________________Phone (W)_________________e-mail ________________________
Age Range (please circle one category): 12-15 16-18 19-25 26-55 55 & up
I have been tapping for ______years. I have studied with _________________________________
_____________________________________________________________________________
I teach at: _____________________________________________________________________
Tap Level (please circle one level):     Beg.     Fast Beg.     Int.     Hi Int.     Adv.     Pro.
JTE HOLIDAY WORKSHOP LA -- THE TAP WORKSHOP
  $365.00 Platinum Card (24 classes & Jazz Bakery (Dec. 29 & 30) & T-shirt) $________
  $335.00 Gold Card (20 classes & Jazz Bakery Dec. 29 & 30) & T-shirt) $________
  $290.00 Afternoon Dancer (3 afternoon courses & Jazz Bakery (Dec. 29 & 30 & T-shirt) $________
  $215.00 Early Bird Dancer (2 morning courses & Jazz Bakery Dec. 29 & 30)& T-shirt) $________
  $125.00 Single Course (5 classes) $________
  $100.00 Single Course (4 classes) $________
  $80.00 Kids On Tap $________
 Saturday Welcome Jam is free to all enrolled students. 
EVENTS  (Please check all applicable)
 Jazz Bakery Benefit Performance Dec. 28 ____Tickets @ $100$________
 Jazz Bakery Dec. 29 ____Tickets @ $25*$________
 Jazz Bakery Dec. 30 ____Tickets @ $25*$________
 Tickets are $30 at the door. 
Amount Due For Classes and Events$________
NON-REFUNDABLE REGISTRATION FEE:$ 25.00      
 Total Amount Due    $________
 Amount Enclosed    $________
 Balance Due    $________
Enclosed is my check for $_______________. Please make your check payable to Jazz Tap Ensemble.
Please charge my credit card:_____American Express_____Master Card_____Visa_____Discover
Card No.______________________________________________________ Exp. date:______________
Authorized Signature:_______________________________________________________________
 
Please circle selected Courses:(A) Adv/Pro: Weber(B) Intermediate: Sumbry-Edwards
(C) Adv/Pro: Sumbry-Edwards(D) Int/Latin Rhythms: Dally(E) Adv. Beg.: Grant
(F) Int/Adv/Pro: Dally & Kalaf (H) Advanced: Grant (J) Intermediate: Weber
(K) Improvisation

Mail to: Jazz Tap Ensemble- 1416 Westwood Blvd. #205, Los Angeles, CA 90024 or
Fax to: 310-475-4037 (credit card and check registration check must be received by 11/28/03)

Schedule subject to change. Class sizes are limited. Enrollment is on a first come, first serve basis.
HOTEL: Beverly Laurel Hotel 8018 Beverly Blvd., L.A., CA 90048 Reservations: 323-651-2441
Ask for Jazz Tap Ensemble Group Rates.