Blueprint Registration Form

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126 East 13th Street
New York, NY 10003
U.S.A
212.505.0886
info@peridance.com

Peridance Capezio Center BLUEPRINT Registration Form

Your Information

* - Required Information

Full Name:

Age:

Gender:

Address:

City:

State:

Zip code:

Phone:

Email:

(If Under 18 Years of Age) Parent/
Guardian Name:

Years of Ballet Training

In the past five years where have you danced? Please list all major professional experience and teachers:

Please give us a brief description of your goals and expectations relating to BLUEPRINT:

How did you hear about this Summer Intensive?

I would like information about housing:

Auditions
2011

	New Orleans: November 2011
	Washington DC: November 26th, 2011, 1:00-2:30 PM

New York at Peridance Capezio Center

	Tuesday, January 3rd, 2012, 5:30-7:00 PM
	Sunday, March 4th, 2012 2:30-4:00 PM
	Sunday, April 15th, 2012 2:30-4:00 pm

Auditions
2012

	Amsterdam, The Netherlands: February 11th, 2012, 11:00-12:30 PM
	Milan, Italy: February 13th, 2012, 11:30-1:00 PM
	Torino, Italy: February 14th, 2012, 3:00-4:30 PM
	Rome, Italy: February 15th, 2012, 9:00-10:30 AM
	Rome, Italy: February 15th, 2012, 12:00-1:30 PM
	Naples, Italy: February 16th, 2012, 3:30-5:00 PM
	Chicago: February 25th, 2012, 11:30-1:00 PM
	Dallas: March 11th, 2012, 2:30-4:00 PM
	Miami: March 24, 2012 1:00pm - 2:30 PM

I cannot attend any of the public auditions. I would like to send a DVD to Peridance Capezio Center to be reviewed. DVD submissions for BLUEPRINT must be postmarked by May 31st, 2012 to be considered. (Click here for specific DVD instructions).

To ensure your place in the audition, registration deadline is 1 week before the audition day!
If you have additional questions, please contact us at blueprint@peridance.com

Audition Fee: $20 (Audition fees are non-refundable)
If you are unable to pay online please contact us at: 212-505-0886

Credit Card Information

Credit Card:	*
Name on Card:	*
Card Number:	* Required Information
CIV Code: What is this?	*
Expiration Date:	/ * Required Information (mm/yy)

In order to prevent spam please type the two words you see above.

If you have are having difficulty submitting this form, or have questions, please call us at 212-505-0886 or email us at info@peridance.com

Audition Fee: $20 (Audition fees are non-refundable) If you are unable to pay online please contact us at: 212-505-0886

If you have are having difficulty submitting this form, or have questions, please call us at 212-505-0886 or email us at info@peridance.com

Audition Fee: $20 (Audition fees are non-refundable)
If you are unable to pay online please contact us at: 212-505-0886