Dance in Fall with “ Scott, Rachael, Joey, Rob, Nelson, Cathy - Oct 19-20 Canada

                         Friday Performance:  Emcee - Rob Glover,  Emily Woo  &  Francis Chan

       Saturday Workshop:  Deejay/Emcee:  Michele Carver                Equipment:  Eddie & Rhoda   

     Friday    -   October 19, 2012    (Performance in Markham Theatre from 8:00 pm to 10:30 pm)                                                                                

        Saturday    -   October 20, 2012     (Thornhill Community Centre – Space Limited)                     ** No Video Taping    

 Pre-registration:  $  90.00   (Register before Sept. 10, 2012 – Fee includes Friday Night Performance & Saturday Workshop)                                                                                                                 $105.00  (Register after Sept. 10, 2012)

             Friday    (Oct. 19, 2012)    Performance in Markham Theatre  from  8:00 pm  to  10:30 pm

        Saturday (Oct. 20, 2012)   Door Open  11:30 am           Class start  at   12:00 pm (Full day snacks, beverages & dinner)                                                                                         

                                                                            Dinner            06:00 pm   to   07:00 pm

                                                   Night dance starts from          07:00 pm    to   Midnight  12:00 am

    Friday Night Location:      Markham Theatre, 171 Town Centre Blvd., Markham, On L3R 9W3

    Saturday  Location:  Thornhill Community Centre, 7755 Bayview Ave., Thornhill, On L3T 4P1

     For more information please contact:

  Lily  Choi:  905-534-0119                            Or       E-mail to:   lily.choi5@gmail.com

  Helen  Chen:  905-557-0157                                Website       www.wix.com/lilychoi_line/Dance-Toronto

  *** By mail, please make check payable to  LILY CHOI  &  send  to:  20 Thoroughbred Way,

         Markham,  On L6C 0B6   &  remember to provide Return Address  ***

  This form will be considered your  Ticket  for the “Dance in Fall with “ Scott, Rachael, Joey, Rob, Nelson, Cathy” event and only       valid with ticket  number assigned  & signature of the organizer – Lily Choi                                No Refund unless event is cancelled

Name:  ____________________________________________   Ticket No.:  ________________

Check #: ______________ or   Cash: $ _____________  Instructor: _______________________

        Dance in Fall-Friday Night Performance & Saturday Workshop with Scott, Rachael, Joey, Rob, Nelson, Cathy

                     Friday  & Saturday – October 19 & 20,  2012            $90.00 (Pre-registration – before September 10, 2012)                                                                   

Name:  _________________________________________________   Ticket No.: ___________

E-mail Address: _________________________________________________ Phone #: ____________________

Check #:  _________________  or Cash:  $__________________  Instructor: ____________________________

I, the undersigned, for myself, my heirs, executors and administrators hereby waive and fully release and agree to hold harmless the “Dance in Fall

with Scott, Rachael,  Joey, Rob, Nelson, Kathy, Louie” its organizers, employees and their agents harmless from any and all lawsuits, claims, demands  of any and every kind and character arising from and in connection with this event, whether as a spectator, staff member or attendee. I understand the physical risks of social dancing and assume full responsibility for any injury or personal damages resulting from “Dance in fall with  Scott, Rachael,  Joey, Rob, Nelson, Cathy”.  I hereby authorize the reproduction, sale, copyright, exhibition, broadcast and / or distribution  of any event video

tape and photograph of  me during all  the accompanying activities on October 19,  2012 to October 20, 2012 without limitations.  I certify that I am over the age of 18 years.  Otherwise, parent or legal guardian signature is required.

Signed By Dancer: ____________________________________Date:___________________