G.R.E.S. Samba Mundial
A community based 501(c)3 Non-Profit Samba School
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San Francisco Carnaval 2012 On-line Registration Form
Thank you for your participation in
Samba Mundial.
. Please complete the form below and then bring your check to a Saturday rehearsal.
First Name or Initial
?
Please enter your first name.
Middle Name or Initial
?
Please enter your middle name or middle initial.
Last Name
?
Please enter your last name.
Suffix (Jr., III, etc.)
?
Please enter a suffx, title, or leave blank.
Child (under 18)?
No
Yes
?
Check "Yes" if registering someone under 18.
Student?
No
Yes
?
Please check "yes" if you are a student.
Gender:
Male
Female
?
Please select your gender.
If registrant is a child please enter parent's name.
Parent's Name
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Parent or guardian's name if registrant is a minor.
Mailing Address
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Please enter your address.
Address (cont.)
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Address line two (Apt. # etc.)
City
?
Enter City.
State
Not Selected
Armed Forces Americas
Alberta
Armed Forces Europe
Alaska
Alabama
Armed Forces Pacific
Arkansas
American Samoa
Arizona
British Columbia
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Federated States of Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Manitoba
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
New Brunswick
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
Newfoundland and Labrador
New Mexico
Nova Scotia
Northwest Territories
Nunavut
Nevada
New York
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Palau
Quebec
Rhode Island
South Carolina
South Dakota
Saskatchewan
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Yukon Territory
?
Select State.
Zip
?
Please enter you zip code.
Cell Phone (Area)
?
Area Code for your cell phone.
Cell Phone
?
Cell phone number.
Home Phone (Area)
?
Area Code of home phone.
Home Phone
?
Home phone number.
Work Phone (Area)
?
Area Code of work phone.
Work Phone
?
Work phone number.
Extension
?
Extension for work phone.
Home email
?
Please enter your personal email address.
Mailings to this email
?
Is this your preferred email address?
Work email
?
Please enter your work email.
Mailings to this email
?
Is this your preferred email address?
Role: (select one of the following roles)
Dancer
Bateria
Parade Monitor
Other Role:
?
Please select what you would like to do in the parade.
Other Role
?
Please enter another role not listed.
Need hat?
No
Yes
?
Please indicate if you will need a hat.
Shirt Selection: (Please specify the shirt size and type)
Not Selected
Child's Small
Child's Medium
Child's Large
Women's Small
Women's Medium
Women's Large
Women's Extra Large
Men's Small
Men's Medium
Men's Large
Men's Extra Large
Men's XXL
Men's XXXL(3X)
Men's XXXXL(4X)
Men's XXXXXL(5X)
?
Select your preferred T-Shirt Size.
Comments or special instructions:
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Please let us know anything else we might need to know, or leave blank.
OK. I hate these things too! But the "Form-bots" already found our little form and starting sending junk messages to the Database with embedded URLs. So like dealing with "SPAM", these "captcha" devices are now a necessary part of the Internet. Sorry!
Please enter the code to the right.
?
Enter the cryptic looking alphanumeric code to the right of the text box.
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