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Event Registration

First Name
         
Last Name
         
Street
         
City
          
State
          
Zip
          
Phone
         
E-mail
          
Register me for Gina Workshop - Day 1
      
Register me for Gina Workshop - Day 2
     
I wish to perform in the Show (10-minute maximum)
  
Solo Group Duet
My / Our Stage Name    
Name of Music  

Gina Workshop fee is $65 in advance (by July 12, 2008) for each day. After that, the fee is $75.
If you pay by check or money order, please make payable to Samira Saleem and mail to:

Samira Saleem
2503 Holly Point Road West
Orange Park, FL 32073

 
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