Australian Hellzapoppin' Prize: Entry Form for Couples

AHP

Entry Form

This entry form is for couples who already have a partner. If you do not have a partner but would still like to enter, please fill out an Individual Registration form as soon as possible so that we can attempt to match you up with a partner prior to entry.
Completion of an entry form does not guarantee registration. Selected registrants will receive confirmation prior to Tuesday, 29 October 2002.
Payment of entry fee of $25 per couple by cheque or money order payable to SwingShift Melbourne to be made by November 10, 2003 (one week prior to competition).
Only one applicant per couple need apply.

Full Name:
Partner's Name:
Street:
City/Suburb:
State:
Postcode:
Phone:
Email:
Comments:

PLEASE READ AND AGREE

I have read and understand the Competition Entry Requirements and understand the risks involved in dance activity, and acknowledge that the organisers of The Australian Hellzapoppin' Prize can not be held liable for any damages I might incur as a result of taking part.