13th USA Hip Hop Dance Championship
Official Entry Form - 5-8 Member Crew
August 2–4, 2014 at the Red Rock Resort ● Las Vegas
Return by July 1. Entries received after July 1 will incur a $50 late fee per crew)
CREWMEMBER ENTRY FORM This form must be completed by each
CREWMEMBER (one per crewmember)
Please fill out the following form completely. An entry form must be completed and signed by each crewmember.
CREW Name
City/State Crew Represents
Crews will be announced and identified by their crew name and the City/State they represent.
Specify:
Junior
Name
(7-12) Varsity
(13-17) Adult
Date of birth
Age
Address
M
F
T-Shirt (Adult Size)
City
State
Email
CrewLeader Name
(18+)
Zip Code
Phone
CrewLeader Phone
CrewLeader Email
WAIVER:
In consideration of the acceptance of my entry, I the undersigned am legally bound for myself, my heirs, successors, and assigns do
hereby waive and release Hip Hop International, the USA & World Hip Hop Dance Championship, its sponsors, host venues and
all persons and agencies connected with this competition from all claims for damages arising from my participation in and travel
to and from this competition, including without limitation, personal injury. I certify that I am in good health, physically fit and
adequately trained to participate in this event. I grant permission to all the above mentioned to use my name and likeness for any
purpose. I understand that if I qualify to represent the USA in the World Hip Hop Dance Championship August 5-10, 2014 I will
be required to pay a separate $25.00 entry fee if I choose to participate.
Signature of participant (18 and over)
Date
Signature of Parent/Guardian for participant under 18
Date
Registration Fee: $50 per crewmember - which includes all championship registration costs, official tshirt and invite to celebration party and admission to all USA & World Hip Hop Dance Championship
events and World Battles. (Entry Fees are non-refundable)
Registration fees for the entire Crew will be paid in one payment by the Crew Leader –
please pay your registration fee to your Crew Leader.
Send entry forms by mail, fax or email to: Hip Hop International – 8033 Sunset Boulevard, #920, Los Angeles, CA 90046
Email: [email protected] Fax: 323.850.7795 Phone: 323.850.3777
13th USA Hip Hop Dance Championship
Official Entry Form - 5-8 Member Crew
Please complete the following form. A crewmember entry form must be also be completed by each crew member.
Return by July 1.
Entries received after July 1 will incur a $50 late fee per crew)
CREWLEADER ENTRY FORM This form must be completed by the
CREWLEADER (one per crew)
CREW Name
City/State Crew Represents
Crews will be announced and identified by their crew name and the Country they represent.
CREW LEADER Name
Address
City
State
Email
Phone
Specify:
Junior
(7-12) Varsity
Zip Code
(13-17) Adult
(18+)
Please list crewmembers names and the age they will be on the first day of competition:
1.
Age:
5.
Age:
2.
Age:
6.
Age:
3.
Age:
7.
Age:
4.
Age:
8.
Age:
Registration Fee: $50 per crewmember - which includes all championship registration costs, official tshirt and invite to celebration party and admission to all USA & World Hip Hop Dance Championship
events and World Battles. (Entry Fees are non-refundable)
Total:
**Crew leaders must collect all crewmember entry fees and submit one payment for the entire crew.
Crew registration fee paid by: Mastercard
VISA
CARD NUMBER:
AmEx
Discover
Money Order or Bank Wire (bank wire details upon request)
SECURITY CODE:
CARDHOLDER NAME
EXP. DATE
(please print) SIGNATURE
CARDHOLDER ADDRESS (if different from above)
City
CARDHOLDER PHONE NUMBER
State
Zip
CARDHOLDER EMAIL
Send entry forms to: Hip Hop International – 8033 Sunset Boulevard, #920, Los Angeles, CA 90046
Phone: 323.850.3777 Fax: 323.850.7795 email: [email protected]
Country