JANUARY INDIA NITE 2010 -- PARTICIPANT APPLICATION FORM All individuals listed on this form must be current members of India Association. Deadline for all applications is January 15th, 2010. UTube/ Videos of performance must be submitted by January 9th. Rehearsal is on Sunday january 16th at the Mountain View Center, 8625 E Mountain view, Scottsdale, AZ 85258. All organizers must attend rehearsals to collect tickets for participants and make payments for membership. * Required Field ORGANIZER INFORMATION  (Main contact responsible for communicating with all participants).  The person completing this form must provide the complete name for all participants and parents (where appropriate). Application forms will be rejected for incomplete information and if we are unable to verify membership due to incomplete information. Last Name: * First Name: * Street Address: * City & Zip: * Preferred phone: * Alternate Phone: Email Address: * PROGRAM ITEM INFORMATION Item Name: * Item information will be printed on certificates and the program brochure as entered on this application form!!! Description: * Describe your item as completely as possible.  The description provided here will be printed on the program brochure. Category: --Select One-- Classical Dance Fusion Dance Medley/Bollywood Dance Folk Dance Drama Classical Music Light Music * Age Group: --Select One-- Age 9-13 yrs Age 14 and over * FIRST CHOREOGRAPHER/DIRECTOR/COMPOSER Last Name: First Name: Street Address: City & Zip: Preferred phone: Alternate phone: Email Address: SECOND CHOREOGRAPHER/DIRECTOR/COMPOSER Last Name: First Name: Street Address: City & Zip: Preferred phone: Alternate phone: Email Address: PARTICIPANT INFORMATION Maximum number -- 20.  Minimum number --4 Enter complete information for parents to help us verify membership. Applications with insufficient information will be automatically rejected. Verify spellings of all names as these will be printed in the Program Brochure and Certificates as entered on this form!  Participant 1 Last Name: * First Name: * Parent Name (First and LastName required): Phone: Email: Participant 2 Last Name: * First Name: * Parent Name (First and LastName required): Phone: Email: Participant 3 Last Name: * First Name: * Parent Name (First and LastName required): Phone: Email: Participant 4 Last Name: * First Name: * Parent Name(First and LastName required): Phone: Email: Participant 5 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 6 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 7 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 8 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 9 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 10 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 11 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 12 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 13 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 14 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 15 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 16 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 17 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 18 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 19 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Participant 20 Last Name: First Name: Parent Name (First and LastName required): Phone: Email: Click Here to Print the Guidelines Agree with guidelines: *

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