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BurlyBenefactor 2017 Registration: $600/year

BurlyCon, November 9-12, 2017, is an annual burlesque social and educational convention held every fall in the Seattle area. 

For $600 annual subscription you will be supporting BurlyCon all year round and receive some fabulous items.

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One Time
Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
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State/Province
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I attest, as a participant in BurlyCon, that should the participant take part in the aforementioned exercise program, the participant is physically fit to participate in the convention known as and associated with any BurlyCon classes, workshops, panels, and events. In participating in BurlyCon LLC, including, but not limited to any individual or group classes, workshops, panels, and events, or other activity organized by BurlyCon, I hereby waive and release all claims, liabilities, actions, damages, costs or expenses of any nature whatsoever for injuries the participant might sustain, known or unknown, arising out of the program now or at all times in the future. I understand that certain corrections may include manual physical contact and manipulation. I recognize and acknowledge there is risk associated with participating in the activities associated with the instruction of dance, physical theater, and movement exercises, and I agree to assume total risk of any such activities connected with BurlyCon. I accept liability for any property damage that may occur as a result of participant's instruction, and I understand and accept that no promises or guarantees are made, explicit or implied.
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By signing below, I acknowledge that all class content, including but not limited to teaching method, curriculum, discussions, written materials, movements, dance steps, routines, choreography, and other processes and material (hereafter referred to as "Proprietary Information") are the property of BurlyCon Presenters and constitute confidential and proprietary business information and trade secrets, the unauthorized disclosure or distribution of which will irreparably harm the Presenters. I further agree that in exchange for BurlyCon's agreeing to take me on as a participant, I agree to keep the Proprietary Information confidential and that I will not disclose the Proprietary Information to anyone without prior written consent of the individual Presenters. I further agree that I will not teach to any third party any of the Proprietary Information, and that I will refer any person wishing to learn any of the Proprietary Information to the BurlyCon Presenter. I further expressly agree that I will not use the Proprietary Information for the purpose of soliciting any students or members of BurlyCon or to otherwise compete with BurlyCon.
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I agree that as a participant in BurlyCon I will allow my likeness to be captured in film and video for promotional purposes only. I agree that BurlyCon holds the copyright to all images and video taken of me during the Convention.
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If you do not provide your actual date of birth you will be required to show your ID at Registration and the BurlyBar.
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By checking this box I understand that I will receive the following benefits: Recurring automatic payment with option to renew annually, BurlyCon Weekend Pass, Dinner with the Board of Directors and Guests of Honor during BurlyCon, BurlyCon T shirt, Personalized thank you note from the BC Board of Directors, Quarterly newsletter from the Board about BurlyCon’s non-profit activities, Stage name listed on website as a BurlyCon Benefactor, “I am a BurlyCon Member!” sticker, Good feelings!
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As a Burly-Benefactor, we will continue your membership through automatic renewal each month on your credit card for as long as you wish without interruption, unless you tell us in writing otherwise. We will simply charge your credit card $40 each and every month. Should terms or rates change, we will notify you in advance. If we cannot charge your credit card we will send you a bill for your dues. To qualify for the BurlyBenefactor Benefits, all 12 payments must be in or $600 paid in full, up to date, and prior to 2 weeks before the annual convention. BurlyCon cannot honor all dietary requests during the dinner, but we try to have a range of foods that everyone may eat. Alcohol is not included as a part of the dinner.
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I understand that I can NOT receive a refund for any part of this registration. I understand that once purchased this registration is considered a donation to BurlyCon and can not be refunded. If you find you are unable to attend, then let BurlyCon know and we will send you a donation letter for tax purposes in lieu of your attending the convention.
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I understand that I can NOT give, donate, sell or otherwise transfer this registration to another person.
BurlyCon collects the following sexuality, gender, race, and ethnicity information data for grant writing purposes.

The language and format for reporting is based upon our needs for completing grant applications.  We understand that the language in the following data has social, cultural, and political shortfalls and the questions and answers may not reflect the views of BurlyCon or its staff.

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