ARISING QUEEN

September 20-30,2013 held in Spain and Morrocco

Please fill out a registration form for each person attending.

*Last Name: Middle Name:

*First Name:

*Email: Secondary Email:

*Home Phone: Cellphone: Work Phone:

Street Address: City:

Prov/State: Postal Code/Zip:

$1000.00 deposit to be paid by July 31, 2013

Balance of Payment to be paid in full by August 19, 2013