2017 NATIONALS COMMITMENT

2017 NATIONALS COMMITMENT
JULY 3-7, 2017 - FOXWOODS RESORT, CT
Submit this form with a $500 deposit to secure your place at HEADLINERS NATIONAL CHAMPIONSHIPS at
Foxwoods Resort, CT from July 3-7, 2017. In addition, return the form by January 15, 2017 to receive our exclusive
offer of 10% off your National Championships Entry Fees! Discount is applicable to studios with a minimum of
$3500 in entry fees. 10% will be applied to all groups, class, production, and extended routines (Solos, Duos and
Trios are counted toward the $3500 minimum).
Estimated Number of Routines: _______________________
Studio Name: _____________________________________________________________________________________________________________
Phone Number: _________________________________
Email Address: _________________________________________________
Name of Cardholder: ____________________________________________________________________________________________________
Billing Address: __________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Credit Card Number: ____________________________________________________________________________________________________
Credit Card Expiration: _________________________________
3 Digit Code: __________________________________________
A $500 deposit is now due and will be applied to your final balance due. Entry fees may be paid by studio check,
money order, or by credit card. Check off your payment preference below.
_________ I will pay by check or money order.
_________ I will pay by credit card. (A 3% service fee will be applied for all credit card payments.)
I acknowledge and agree to all of the above. In addition, I understand that we are required to submit entries to
Nationals and pay in full by May 15th, 2017 or our place and discount will be forfeit. I also agree to and understand
that the deposit is non-refundable and there are no refunds, including those due to scheduling conflicts.
Signature: _________________________________________________________________________________________________________________
Print Name: _______________________________________________________________________________________________________________
MAIL THIS AGREEMENT AND CHECKS TO:
Headliners, 11 Middlebury Blvd, Unit 1, Randolph, NJ 07869
(Your credit card will not be charged unless you have indicated to do so)