March 10th & 11th, 2018

Northern Kentucky University
Nunn Dr
Newport, KY 41099
www.nku.edu

Workshop Registration

Please note: Cincy Stage Combat Workshop will not be offering Skills Proficiency Renewals this year.

Personal Information First Name Last Name Street Address Address Line 2 City State ZIP Phone Email Address List any limitations or conditions affecting your participation in the Cincy Stage Combat Workshop, including food allergies.

I certify that I am either 18 years of age or older, or that I am 15 years or older and have my parents' permission to participate.

Registration

Fee includes catered breakfasts and lunches, and a t-shirt!

Check this box to agree to the blood-borne pathogen policy.

2 Day (Full) Registration ($200)

Early Registration Discount ($25 discount)

Union or Student Discount ($25 discount)
Check if SAFD, AEA, or AFTRA member, or if student with valid ID

1 Day Registration - Saturday ($150)

1 Day Registration - Sunday ($150)

Total $

Fee includes catered breakfasts and lunches, and a t-shirt!

T-shirt Size

Payment

Paypal / Credit Card

You can now use Paypal for easy payment of your registration! Please allow a 4% service charge, which will be added to your total on the next page.

Check

Cashier's Check

Money Order

Please make all checks and money orders payable to:

Jonn Baca
4591 Summerside rd. Apt 6
Cincinnati, OH 45244

March 10th & 11th, 2018

Workshop Registration

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