2018 Teacher Training Program Registration

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2018 Teacher Training Program Registration
Thank you for your interest in the 2018 USA IBC Teacher Training Program. The teachers seminar is designed as a two-week program, June 10-23. All participants must attend the full session. Before you begin your application, please collect the following items:
- Credit Card for payment.
- Color Photo Headshot for ID Badge (to be attached as a jpeg).
If you have any questions about the application process, please email Arianna Marcell at amarcell@usaibc.com.

PERSONAL INFORMATION
Name*
First Last
Birthday*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Adress*

This email address will be used for all USA IBC Teacher Training Program communication.
Cell Phone*
Work Phone*
Dance School or Affiliation*
Years of Experience as a Ballet Instructor*
Have you attended a teaching seminar with Victoria Schneider?*
HEADSHOT:
Headshot (in color) - photos must be no smaller than 5" x 7" (13 x 18cm). Please save your headshot file as LAST NAME_HEADSHOT. For example: SMITH_HEADSHOT.
Upload Headshot Here:*
Maximum file size: 64MB

MEDICAL INFORMATION
Please list any / all allergies:*
Any presently existing or persistent condition, infection, or injury?*
EMERGENCY CONTACT INFORMATION
Emergency Contact Name:*
First Last
Relationship to Applicant:*
Cell Phone:*
Work Phone:*
Consent for Medical Treatment & Liability Release
PLEASE PRINT THIS PAGE FOR YOUR RECORDS
I authorize any emergency medical treatment that may be required during the USA IBC Teacher Training Program from June 10-23, 2018. I understand that I am responsible for any and all payments as a result of such care or medical treatment. I hereby release the USA IBC and Ballet Mississippi and their agents, employees, and volunteer assistants, from liability whatsoever arising out of any injury, damage, or loss which may be sustained by me during the Teacher Training Program. By selecting "I Agree" from the drop down menu below and signing this document electronically, I agree with the policies, terms, and conditions set by the USA International Ballet Competition. I understand that the IBC staff and faculty are in a place of authority for my benefit and protection, and I will honor their leadership while I am attending this workshop. I realize that there will be people from all backgrounds at the USA IBC Teacher Training Program, and I will show respect for each student, teacher, and faculty member.
Choose From Drop Down Menu Below:*
Electronic Signature*
First Last
Date*
Please Choose One of the Tuition Package Options Below:*

Teacher Training Payment
A minimum $100 deposit is required to complete this application. However, you have the option to pay in full at this time. Please select the appropriate payment below.
Deposit or Full Payment*
Teacher Training Deposit*
Price: $100.00
NON-REFUNDABLE
Standard Package Full Payment*
Price: $1,300.00
Premium Package Full Payment*
Price: $1,700.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address (where you receive credit card statements)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PERSONAL INFORMATION