March 16th & 17th, 2019

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.

Your registration will be processed as "Pending" until we confirm payment. Upon payment, you will receive an email confirming your registration. If your balance is not paid in full by March 1, 2019, your slot will no longer be held. If there is a waiting list, the slot will be given to the first person on the list.

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 16th & 17th, 2019

Workshop Registration

Questions? Call or Email us at:

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