Workshop registration form
(Please print out and fill out.)
Name__________________________________________
email__________________________________________
address_________________________________________
______________________________________________
phone #________________________________________
10am __________
11am __________
12pm __________
1 for $25, 2 for $35, 3 for $45 Total payment__________
Entrance into Shimmy Shake and Share free.
Please make checks out to St. Andrew Lutheran Church and write
W.H.O.-SSS on the memo line.
Send them to:
Shimmy Shake and Share
36516 NE Lakeview dr.
Yacolt WA, 98675
Please read and sign the following release:
“I hereby release Troupe Raks el Sehr and St. Andrew Lutheran Church and all workers from any liability for any injury incurred or loss or damage of property in association with the 2018 Shimmy, Shake, and Share.
Sign:__________________________________________ Date:________
An email confirmation will be sent to you when your payment is received.
11am __________
12pm __________
1 for $25, 2 for $35, 3 for $45 Total payment__________
Entrance into Shimmy Shake and Share free.
Please make checks out to St. Andrew Lutheran Church and write
W.H.O.-SSS on the memo line.
Send them to:
Shimmy Shake and Share
36516 NE Lakeview dr.
Yacolt WA, 98675
Please read and sign the following release:
“I hereby release Troupe Raks el Sehr and St. Andrew Lutheran Church and all workers from any liability for any injury incurred or loss or damage of property in association with the 2018 Shimmy, Shake, and Share.
Sign:__________________________________________ Date:________
An email confirmation will be sent to you when your payment is received.