2018 Belly Dance Competition USA™
Name____________________Dance Name_________________Years Exp.____
MAKE CHECKS PAYABLE TO: Mezdulene
Credit Card____________________________Exp. Date___________CSV#_______
Zip code of card billing address__________________
I authorize Jareeda, Mezdulene, Mystical Oasis, The Belly Dancer U.S.A. Competition(TM) entities, Associates and/or heirs to use or sell any or all photos or videotapes taken during said competition, for educational, promotional and professional purposes. Any competitor winning any category of The Belly Dancer U.S.A. Competition(TM) agrees to use the title of that category correctly for publicity purposes. Competitors assume all responsibility and liability for themselves and all personal property. All applications, forms, contracts, releases, moneys, etc. must be signed by competitor and received by The Belly Dancer U.S.A. Competition or its staff, before being accepted into any category in the Competition. If I am crowned winner of The Belly Dancer U.S.A. Competition(TM) category, I agree to return the following year to perform in the evening show and present that year's winner his/her crown. I agree to abide by all "Rules of The Belly Dancer U.S.A. Competition(TM). I agree to the above, and I do hereby release Jareeda, Mezdulene, Mystical Oasis, The Belly Dancer U.S.A. Competition(TM) and anyone working with or connected to the Belly Dancer U.S.A. Competition(TM) ) from any claims for any kind of damages, loss, theft or injuries incurred while participating in this competition.
Signature and date.___________________________
Mail to Mezdulene, P.O. Box 680, Sutherlin, OR 97479