Registration




Purchaser or Student*

First Name:

Last Name:

Email:

Phone Number:

Address:

Additional Student

First Name:

Last Name:

Email:

Phone Number:

Address:

General Questions*

Dance Experience
 None

 Beginner

 Intermediate

 Advanced

What type of dance would you like to learn? (please check one or more)
– Standard
 Tango
 Foxtrot
 Waltz
 Quick Step
 Viennese Waltz
 Argentine Tango
– Latin
 Cha Cha
 Rumba
 Samba
 Jive
 Swing
 Salsa

What is your expectations for taking this class(es)?

Special Promotion (groupon voucher number or living social etc.)

*required