REGISTRATION INFORMATION


Congratulations on receiving a full free confernce! Please fill out the form with the workshops/lectures you wish to attend. 

LEGAL NAME *
LEGAL NAME
ADDRESS *
ADDRESS
PHONE *
PHONE
EMERGENCY CONTACT NAME *
EMERGENCY CONTACT NAME
EMERGENCY CONTACT NUMBER *
EMERGENCY CONTACT NUMBER
SELECT WORKSHOPS / LECTURES YOU WANT TO ATTEND
ADDITIONAL ITEMS INCLUDE
- Keynote Lecture - Panel Discussion - One Ticket to Friday evening Hafla of Shimmies - Saturday and Sunday morning snacks - Break Room (Coffee, Tea & Water) - Shopping NOTE: Does not include ticket for the Saturday show, Spectacular Shimmies
PHOTO & VIDEO WAIVER *
I understand that I may be photographed or filmed while participating in any events at Shimmy Con. Photos or video might be used for any publicity purposes for Shimmy Con.
I hereby assume all of the risks of participating in any/all activities associated with Shimmy Con. I understand and agree that in participating in any dance class, workshop, lecture, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me during any of Shimmy Con’s events, classes, workshops, lectures, rehearsals, performances, or activities. I understand that I should be aware of my physical limitations and agree not to exceed them. I also exempt, release, and indemnify Shimmy Con, its owners, agents, volunteers, assistants, employees, guest artists, guest instructors, guest speakers, the Monroe Convention Center, the Buskirk-Chumley Theater and all other entities involved in presenting Shimmy Con from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, or property which may arise out of or in connection with participation in any classes or activities conducted by Shimmy Con. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Shimmy Con, its owners, agents, volunteers, assistants, employees, guest artists, guest instructors, guest speakers, the Monroe Convention Center, the Buskirk-Chumley Theater and all other entities involved in presenting Shimmy Con liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. I certify that I have read and understand this document. I am aware that this is a release of liability and agree to be bound by the above statement. TYPE FULL LEGAL NAME TO CONFIRM THAT YOU HAVE READ AND AGREED TO THE ABOVE STATEMENT.