CAMP REGISTRATION FORM

Name _______________________________________         O M        O F

Address ______________________________________________________________________________________________

Phone __________________

E Mail_______________________________________

Do you plan to use your own tent? yes O no O

Are you a vegetarian? yes O no O

Full-time registration O Part-time registration O (dates) _______________________

Total enclosed: $ __________ Balance due: $ ____________

Single(s) O Couple O

Please note: If you are registering as a Single, you will be assigned a cabin with
3 other singles of the same sex. If you are a Couple, you will be assigned a cabin
with another couple unless otherwise specified.

If you have preferred cabin partners please give names. ________________________________________________________

Do you want your name and telephone number appear on camp roster? yes O no O

If you are planning to drive and you are willing to give a ride to another camper
please let us know so that we announce it.

Make check or money order in U.S. dollars payable to Middle Eastern Music and Dance,

and Mail To: Middle Eastern Music and Dance, 3244 Overland Ave., No. 1, Los Angeles, CA 90034.

PHOTO RELEASE STATEMENT: By registering to attend the Middle Eastern Music and Dance Camp, each attendee grants Middle Eastern Music and Dance productions, its employees, agents and assigns; the use of attendee's likeness, voice, sound effects and/or musical performance in photographs, motion pictures, videotapes, and recording media. Each attendee also grants in perpetuity the right to reproduce and/or redistribute in any manner whatsoever the attendees likeness, voice, sound effects and/or musical performance.