Punk Raqs 2008 Dancer Application


Dancing Name / Troupe:
Legal Name(s):


Email Address:
Alternate Email (or confirm Email address):

Cell Phone:
Land Phone:

Mailing Address:
City/State/Zip:

Registered for Workshops: (1) Marjhani 11am-1pm
"Touching Goth Audiences" __yes __no
(2) Ariellah's 1pm-3pm
"Feeling Your Music" __yes __no

Most recent performance:

MECDA Chapter affiliation:

Music for Punk Raqs 2008:

I wish my introduction to read as follows:


Email this completed form to bellydancr@iwon.com
or Fax to 909-381-2791
or send via message to FreeFillDirt on Tribe.net
or via message to on MySpace
at www.myspace.com/mecdaie