CONTEMPORARY DUET REGISTRATION

Note** If not paying by PayPal or credit card, please read the instructions at the bottom of the page.

Note* All dancers competing in the duet competition must fill out this form

for each INDIVIDUAL dancer in the duet and each must pay the fee at the bottom of the page.

Form

If Paying with Paypal or Credit Card

please click “add to cart” and then proceed to Checkout

Contemporary Duet Division
$200.00

If Paying Via Bank Wire

PAYMENT DUE $200 per dancer

(THE DANCER MUST ADD US$15 BANK TRANSFER FEE TO THE PAYMENT). IF FEE IS NOT PAID WE WILL NOT REIMBURSE YOU & YOUR REGISTRATION WILL NOT BE ACCEPTED.

1. CHASE BANK

2. SWIFT CODE : CHASUS33

3. ACCOUNT NUMBER : 755172320

4. ROUTING NUMBER : 021000021

5. BANK ADDRESS : 270 PARK AVE NYC, NY, USA 10017

If Paying by U.S. Check, Please Mail to:

VALENTINA KOZLOVA DANCE FOUNDATION

1725 YORK AVENUE, SUITE 10A

NEW YORK, NY 10128