2nd Annual Southern California Mambo Conference (SCMC) Printed Registration Form

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Follow the directions below for check and money order payments:

1) Fill out the following form:

Name:

Mailing Address:

City/State/Zip:

Daytime & Evening Phone:

E-mail Address:

If You Were Referred
By One of the Conference Instructors or Affiliate Promoters Please Click The Button By Their Name:

Albert	Alma	Ava (SF)		Ben
Anthony		Avillette (NV)		David DJ
David L		Espie (SD)		Diego/Brenda (AZ)
Eileen (DC)		Fede (NM)		Francesca (Fresno))
Francisco/Stacey		Gabriel (SF		Gil/Naomi (SF)
Harry B		Harry F (DC)		Israel (AZ)
Kay		Janette		Mike
Josefina (AZ)		Kristiaan (SF)		Laura
Nelson (NY)		Nory		Oscar/Bethana
Raul		Sabor Magazine		SalsaGang.com (SF)
Salsero Picoso (OC)		SalserosWeb.com		Stephen/Josie (SD)
Salsero Picoso (OC)		SalserosWeb.com		Stephen/Josie (SD)
Steve (NY)		Stracy (NY)	Tony	ToSalsa (TO, Canada)

How Did You Hear About The Mambo Conference?:

(if you were not referred by one of the above names)

As A Dancer, What Level
Do You Consider Yourself?:

Beginner Intermediate Advanced

Make Your Selection:
(If you need to stay at the hotel, please place a number for the amount of nights you want in the appropriate box)

LEGEND:
SO = Single Occupancy
DO = Double Occupancy
TO = Triple Occupancy
QO = Quadruple Occupancy
/N = Per Night

Saturday Pass ($115)

Saturday Dance ($15)

Sunday Pass ($115)

Sunday Dance ($15)

Weekend Pass ($200)

Renaissance Los Angeles Hotel Airport Los Angeles

SO ($130.00/N)
DO ($65.00/N)
TO ($48.00/N)
QO ($40.00/N)

Check-In Date
Check-Out Date
Total Number of Nights

If you are sharing a room, please type in the name(s) and telephone number(s) of the person(s) sharing the room with you in the space(s) below:

Amount Enclosed:

Acknowledgement and Liability Waiver

I understand that my entrance to the workshops or evening dances implies that I consent to the use of my voice and/or image to be reproduced in any promotional material. I understand that there are risks of injury associated with all forms of dancing, and that I assume such risks and agree that Bello Music Enterprises, the Mambo Conference instructors and the Renaissance Los Angeles Hotel Airport Los Angeles will not be responsible in any way for any injury I may suffer in or as a result of the workshops and/or dances at the Renaissance Los Angeles Hotel Airport Los Angeles. I understand that no refunds will be given. I understand that no videotaping will be allowed during the workshops. Your signature below constitutes agreement to the conditions of this waiver.

Signature___________________________________________________

2) Now send the above form (or same info including signed waiver)
and your pre-registration payment (check or money order) to:

Mike Bello
18653 Ventura Blvd, Suite 381
Tarzana, California [PZ] 91356

Mail in payments need to be received not later than
August 22, 2002.

Confirmation will be forwarded via email to those that provide an email address on the registration form (approximately two to three days following receipt of form). This also applies to those that register online. Those without email addresses should receive confirmation via regular post or by telephone approximately 2-3 days following receipt of form. Please email Mambo_Conference@MamboFello.com or call (818) 343-1322 if you have not received your confirmation in the above specified time.

Payments are also accepted at the door, if available, on the day of the event!

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