Kathak Registration Form
INTRO TO KATHAK: Interest Form
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other
Please Specify
*
Please list previous dance training (if any)
*
What days and times work best for you
*
Would you be interested in performing at a later stage?
Yes
No
Maybe
Submit
Should be Empty: