Individual Registration

Please enter information in the form below to process registration for event Dances (Intermediate).

First Name *

Last Name *

Student Date of Birth (yyyy-mm-dd) *

Address *

Address 2

City *

Zip *

Country *

State *

Phone *

Email *

Secondary Email

Shift *

6/16 - 6/27

7/1 - 7/11

Comment

Father Last Name

Father Place of Work

Mother First Name

Mother Last Name

Mother Place of Work

Secondary Phone

Sign up for SMS (Message and data rates may apply)

Payment Information

Amount

$

Payment method *

Offline Payment (New Customers)

Paypal

By registering for this event, I accept Terms and Conditions

Captcha*