Social Dance Registration
Student Information
Full Name
*
First Name
Last Name
Full Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
Contact Number
*
-
Area Code
Phone Number
please select the date of the social dance you will be attending
*
-
Month
-
Day
Year
Date
section separator for the form style - do not remove
Will tickets be available at the door?
Tickets will be available at the door for an additional $5 - cash only
Group Class Tickets:
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( X )
Current Member
$
Free
Students that are enrolled and currently taking private dance lessons at one of our Prestige Ballroom locations
Non-Member Single
$
15.00
Non-Member Couple
$
25.00
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Apply
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card
SUBMIT
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