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Please complete the form below and submit to us. There is a entry fee of $20 per Category entered.
You have two method of payments to choose from.

1.- DIRECT CREDIT can be done to:

Account name:
Bank:
BSB:
Account #:

Quintel Design
Commonwealth Bank
062165
1006 5528

2.- Post CHEQUE or money order to: Quintel Design - PO Box 365 Petersham, NSW 2049, Australia

Once we receive your Entry Form and payment is verified, we will email you a receipt, as a confirmation of
your Registration to the 2nd Annual Australian Bachata Open Championship.
If you have any questions, please contact us on - info@vivamagazine.com.au

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

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