Participant Application Form 2012
Personal Information:
Full name of the participant:Full name of parent / guardian (if 16 and under)):Male Female Date of Birth: Age:
(Date/Month/Year) (Minimum age 12)
Occupation
Address:
Postcode:Email:Tel: Mobile:
Dance Information:
Advanced Intermediate BeginnersBharatanatyamKathak OdissiHow long have you been learning the above style and how many times do you attend the class / practice in a week Please give contact details of the dance teacher:
How did you hear about Dance-India 2012? (e.g. through e-mail/web-site/friend/event/other)Have you attended Dance-India before? Yes 2008 2009 2010 No
Information for Administration Purposes:
For administrative purposes, it is vital that we have details about your accommodation preferences, dietaryrequirements, condition of health, and emergency contact details.
Accommodation:
Accommodation for participants is arranged at Liverpool Hope University Halls, which are on campus just moments away from the Cornerstone Building where classes will be taught
. All the rooms are single room withan en-suite.
Do you need accommodation arranged by Milapfest at the Liverpool Hope University Halls?
Yes No
Dietary Requirement:
Are you vegetarian / non-vegetarian/ Vegan? ---------------------------------------Do you have any other special dietary requirement? (Please Specify) -------------------------------------------
Health Information:
Do you have any health problem that we should be aware of? For example: Asthma, Epilepsy, Diabetes, Heart Problem, Allergies (Please specify)
Contact details in case of emergency:
Name:---------------------------------------------------------------------------------------------------------------------------------------------Land line:--------------------------------------------------- Mobile: ----------------------------------------------------Relationship:------------------------------------------------ Email: -----------------------------------------------------
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