"ACTercise"
Pre-Registration

Enrollment is limited.

Click here for a printable form

Last Name: First Name: Middle Initial:

Permanent Address:

City: Province: Postal Code:

D.O.B.: (m)(d)(yr)     Age:

Home Tel: Cell/Pager:

Work: Email:

Medical & Allergy Alert - Please list any medical or allergy information that we should know:

Have you previously taken an A.C.T. course? Yes / No

How did you hear about A.C.T?

If "Other", please specify:

Why do you want to take this course?

Please provide a brief summary of any relevant acting experience or training:

ACT Permission & Photo Permission

In consideration of A.C.T. accepting me, , in the course noted below, I and my heirs do voluntarily waive and release each and every right or claim for damages we and each of us have or may have against the school, its agents or representatives for any and all injuries or mishaps howsoever occasioned.

I give permission for the use of photographs that may be taken during the workshop or other activities related to A.C.T. to be used by A.C.T. in promotional material for the school.  I understand that there will be no financial remuneration for the use of any photograph.

Name: Date:

ACTercise
TUESDAYS 7:00-10:00, Sept. 27 - Nov. 15, 2005

Payment Options (please check one):

AI will send a current cheque in the amount of $187.25 ($175.00 + GST)

B I will send a current cheque in the amount of $100.00 (non-refundable deposit) to reserve my spot,
together with my cheque in the balance of $87.25 (dated no later than September 19, 2005).

Unless otherwise notified, the workshop will take place at Arts Court, 2 Daly Avenue, Ottawa, ON (between Waller and Nicholas Streets, across from the Novotel Hotel and the Rideau Centre)

Enrollment is limited.
 

Before you click the SUBMIT button below, please print this page and mail a copy with your cheque payable to:  A.C.T.

Send your printed copy and cheque to:

            A.C.T. | ACTercise Registration | 2 Daly Ave. Ottawa, Ontario K1N 6E2

Pre-Registration Forms will be held for one week. If no payment is received within 7 days, your Pre-Registration will become void.

REFUND POLICY:

If you are unable to attend due to illness, we will accept a medical letter no later than one week before the course begins.  A refund minus an administration fee will be given at that time.

Please note that participating in this workshop does in no way guarantee talent representation or any performance related work to the participant.