Name:_____________________________________________________

Address:___________________________________________________

City, State/Zip:______________________________________________

Telephone Number:__________________________________________

Email Address:________________________________________

Competitor’s Information

Date of Birth:_________________Age as of 1/1/08:

Dance School and Teacher:________________________________________

Competitions:___________________________________________________

Amount Enclosed:_____________________________________________

Payment Method: Cash__ Check_Credit_____

Credit Card Number:__________________________ Exp. Date: / / .

Mail to: MJQ Irish Cultural Centre, PO Box 320, East Durham, NY 12423

If your check is not enclosed with your entry, you are NOT registered.

Checks payable to East Durham Feis. Participants may pick up their numbers on the day of the Feis or enclose a stamped, self-addressed envelope. No Refunds.

No registration on the day of the Feis; DOUBLE FEE FOR MISSING CHECKS. ISF fees imposed by the bank will be billed to your dancing school.