Registration Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=100 BGCOLOR="#000000" TEXT="#F7F7FF"> <div> <B>The Murray School Of Irish Dancing</B></div> <div> <A HREF="index.htm" TARGET="_top" TITLE="The Murray School Of Irish Dancing"><U><B>Home</B></U></A><B>  </B><B>   </B><A HREF="irish_dance_school_information.htm" TARGET="_top" TITLE="About Us"><U><B>About Us</B></U></A><B>    </B><A HREF="irish_dance_class_info.htm" TARGET="_top" TITLE="Classes"><U><B>Classes</B></U></A><B>     </B><A HREF="irish_dance_tuition_info.htm" TARGET="_top" TITLE="Tuition"><U><B>Tuition</B></U></A><B>     </B><A HREF="irish_dance_locations.htm" TARGET="_top" TITLE="Locations"><U><B>Locations</B></U></A></div> <div> <A HREF="irish_dance_class_attire.htm" TARGET="_top" TITLE="Class Attire"><U><B>Class Attire</B></U></A><B>     </B><A HREF="irish_dance_events.htm" TARGET="_top" TITLE="Murray Irish Dancers Performance Calenda"><U><B>Murray Irish Dancers Performance Calendar</B></U></A><B>     </B><A HREF="id73.htm" TARGET="_top" TITLE="Summer Irish Dance Camps"><U><B>Summer Irish Dance Camp</B></U></A><B>s</B></div> <div> </div> </td> </tr><tr> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Pre-</B><B>Registration Form</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" >  (<B>Please use separate forms for each student)</B></FONT></div> <div> <B><IMG BORDER="0" SRC="Wing0a7300a700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Leprechaun Dance Camp August 4-8, 2008</B></div> <div> <B><IMG BORDER="0" SRC="Wing0a7300a700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Pirate Camp August 11-15, 2008</B></div> <div> <B>Registration Fee is waved for dance camps, but $100 non-refundable deposit is due at time of pre-registration.  Remainder of  dance camp fees are due by the start of the first day of camp.</B></div> <div> <B><IMG BORDER="0" SRC="Wing0a7300a700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Registering For Dance Class: One Time $25 Registration Fee Per Dancer</B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="723" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 97 WIDTH="711"><div> <B>To guarantee your place in a Murray Irish Dance class or Dance Camp, send your completed form(s) with your Dance Camp $100 deposit or Class registration fee of $25 enclosed to:</B></div> <div> <B>The Murray School C/O The Pacific Festival Ballet</B></div> <div> <B>4620 SW Beaverton-Hillsdale Highway</B></div> <div> <B>Portland, Oregon 97221</B></div> </tD> </tR> </TABLE></B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="718" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="166"><div> <B>Student’s Name</B></div> <bR> </tD> <tD VALIGN=CENTER COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 16 WIDTH="166"><div> <B>Date Of Birth</B></div> </tD> <tD VALIGN=CENTER COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER ROWSPAN=2 HEIGHT= 14 WIDTH="166"><div> <B>Parents Names</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><div> <B>Mother</B></div> </tD> <tD VALIGN=CENTER WIDTH="255"><div> <B>Father</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="34" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 64 WIDTH="166"><bR> <div> <B>Street Address</B></div> <bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="277"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="64" ALIGN="bottom" WIDTH="277" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="64" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 36 WIDTH="166"><div> <B>City, State & Zip</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="36" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="166"><div> <B>E mail Address</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="166"><div> <B>Home Phone #</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="166"><div> <B>Work # (Optional)</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER ROWSPAN=2 HEIGHT= 1 ><NOBR><div> <B>Any Medical Conditions?</B></div> <bR> </NOBR></tD> <tD VALIGN=CENTER ROWSPAN=2 COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 ><NOBR><div> <B>Any Dance Experience?</B></div> <bR> </NOBR></tD> <tD VALIGN=CENTER COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 ><NOBR><div> <B>Irish Dance Experience?</B></div> <div> <B>What School/ How Long?</B></div> </NOBR></tD> <tD VALIGN=CENTER COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 34 ><NOBR><div> <B>How Did You Hear About Us?</B></div> <bR> </NOBR></tD> <tD VALIGN=CENTER COLSPAN=2 WIDTH="535"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="34" ALIGN="bottom" WIDTH="535" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER ROWSPAN=2 HEIGHT= 16 WIDTH="166"><div> <B>I Am Registering For The Following Class:</B></div> </tD> <tD VALIGN=CENTER WIDTH="277"><div> <B>Location/ Day</B></div> </tD> <tD VALIGN=CENTER WIDTH="255"><div> <B>Level/ Time</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER WIDTH="277"><bR> <bR> </tD> <tD VALIGN=CENTER WIDTH="255"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="39" ALIGN="bottom" WIDTH="255" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </td> </tr></table></body>