Viva Magazine : BachataRegi

Thank you for your interest in the 2nd Annual Australian Bachata Open Championship.
Please complete the following form and pay the amount of $20 per Category entered using one of the methods below.
If you have any questions, please feel free to contact us - info@vivamagazine.com.au

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Bachata Competition ENTRY FORM			* Required fields
Payment details: *	Direct Credit Cheque Money Order		# of Categories Entered
Date of Payment: *
Title:
First Name: *		Last Name: *
Address: *
City: *		State: *	Post Code: *
Telephone:		Mobile: *
Email Address: *		Website:
Category you areCompeting	Professional Non Professional Team	IF TEAM Name of the Team?
IF TEAM Name of the person in charge of the Team?		Number of Dancers in the Team?
Dance Partner (full Name): *		Partner Phone: *
Are you representing a Dance School or State? Name of School or State:

By entering this Championship, entrants accept and agree to be bound by the Official Rules