Registration
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LA2NE Dance Convention November 8-10, 2024 All dancers must register and submit payment for complete registration. Early Bird rate of $195 through October 8. If you have a scholarship to use for payment, please email us and we can get you set up. la2nelegacy@gmail.com
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Age (as of 11/01/2024):
*
Studio Name:
*
IF YOU ARE AN INDEPENDENT DANCER (attending without your studio), will you be participating in our Dance Competition?
Yes
No
Additional Information:
Convention Release
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I, the undersigned, have the authority to sign this release on behalf of the persons registered above and/or attached for this convention. The instructors, the convention site, and Legacy Dance & Gymnastics are not liable for any loss/damage of personal property or personal injury of those participating or attending. I also authorize Legacy Dance & Gymnastics to use images of the registered parties for advertising purposes.
All cancellations received after October 1, 2024 will be subject to a $100 non-refundable deposit.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
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08
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Exp Year:
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2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
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2048
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2051
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2053
2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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