"TV Hosting with Confidence"

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 - Health Card #:

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:

Saturday, April 30 & Sunday, May 1, 2005 (10:00am to 6:00pm)

Cost: $299.00
Early Bird Discount: $279.00 (must pay by March 28, 2005)
ACTRA Members and Apprentices: $279.00
*** Class size is limited ***
PRE-REQUISITE(S): None

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)

Payment Options

AEarly Bird Discount (must pay by March 28) & ACTRA Members and Apprentices -    
        Attached, please find my signed registration form and my cheque
of $298.53 ($279.00 + 7% GST) in full payment.

BAfter March 28 (does not include ACTRA Members) - Attached please find my signed registration form and my cheque of $319.93 ($299.00 + 7% GST) in full payment.

CAttached, please find my signed registration form and 3 Cheques.  A current cheque of $100.00 (to reserve my spot), a cheque of $100.00 (dated no later than April 1, 2005) together with my cheque of $119.93 or $98.53 (ACTRA members) dated no later than April 15, 2005.

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. | TV Hosting 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 ($100.00 deposit is non-refundable) 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.