*Name : Gender: Male Female

Telephone :

*E-Mail :

*Do you plan to use your own tent? Yes No

*Are you a vegetarian? Yes No

*Full-time registration* *Part-time registration*

For part-time registration:  

Total enclosed: $ Balance due: $

*Single(s)* *Couple*

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 No

*Are you planning to drive? Yes No

If yes, would you be willing to give a ride to another camper? Yes No

Please send us your comments:

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.