PERFORMER INFORMATION & EMERGENCY FORM

SPECTACULAR SHIMMIES: FRIDAY JULY 7
 

NAME *
NAME
PHONE *
PHONE
(Please provide a cell number. In case the Conference Organizer or Stage Manager needs to reach you on the day of the performance)
EMERGENCY INFORMATION (THIS INFORMATION WILL BE KEPT CONFIDENTIAL)
NOTE: ONLY THE CONFERENCE ORGANIZER AND STAGE MANAGER WILL HAVE ACCESS TO THE INFORMATION
Emergency Phone Number
Emergency Phone Number
I understand and agree to the following (select all) *
Photo and Video Waiver (select all that apply)
Photo and video will be taken of the performance by Shimmy Con. Videos will not be used for publicity unless video is reviewed and permission granted by the performer(s) for use.