Dance Directive Master Class Entry Form

Dance Directive Entry Form

I/We will be attending in the following city: *

Grand Rapids, Mi. Oct 12th

Des Moines, IA. Oct 19th

Kansas City, MO. Oct 26th

Witchita, KS, Nov 2nd

Little Rock, AK. Nov 9th

Tulsa, OK. Nov 16th

Participants *

Please list in following order: Name / Level (Beg/Int/or Adv) / if a Studio Teacher/Owner

Studio Name *

Send Confirmation Email to: *

Contact Name *

Best Phone # to Contact *

Text *

Credit Card *

Visa

Mastercard

AMEX

Credit Card # *

Expiration Date *

Security Code *

3 digit # on back of card

Billing Address *

Apt, suite, etc.

Country

City

State

Zip code

Electronic Signature *

Submitted typed name is considered to be an Electronic Signature

Date *