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First Name
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example@example.com
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Birth Sex
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Male
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Age Group
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19 - 24
25 - 34
35 -44
45 - 54
+55
What's your level
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I never took a class before
I have some dance experience
I'm very comfortable dancing
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When would you like to have your first session?
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What would you like to learn/achieve?
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When would be the best time to contact you?
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