Pole Divas 2006

Participant Registration Form

Full Name: …………………………………………………… 

Date of Birth:  ………………………….

(I confirm I am over 18 years of age)    

Address: ……………………………………………………………

………………………………….…………………………

Post code ………………………………………Profession(s): …………………………………

Contact telephone numbers:  Home ……………………………………………………….

                                                 Mobile ……………………………………………………….

Email address (print clearly) …….………………………………………………………..…    

Entry Level (please circle):     Beginner              Student              Professional

Music Selection

Track 1: No. (if applicable): ........  Name: ..........................................................................

Track 2: No. (if applicable): ........  Name: ..........................................................................

Please bring your music choices on the day of the heat/final or choose from the selection at the bar or on the website at www.pole-play.co.uk

I .............................................................. (name) agree to the rules for the Pole Divas Competition run through Pole Play and accept responsibility for my actions throughout the competition.  I understand if I break any of the rules this may result in disqualification.

___________________________________________________________________

Signed  .............................................................date   ...................................................

Judges decisions are final.  Competitors are required to bring a proof of age to the competition along with photo ID (passport/driving license/student card). Finalists are also required to bring along a passport photo on the day.

Entry level criteria and rules are stated online at www.pole-play.co.uk

Please return this form via email to polekitten@pole-play.co.uk, via post to The Queensway, Ashby Road, Scunthorpe DN16 2AG or drop in to The Vault, Grimsby or The Queensway, Scunthorpe