VXN DANCE CLASS REGISTRATION
VXN with Kenia at Dancewave Studio
Participant Information
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Emergency Contact
Contact Number
*
-
Area Code
Phone Number
Birthdate
-
Month
-
Day
Year
Date
I would be interested in:
MORE VXN DANCE CLASSES
HOW TO GET PRE/POST DRINKS AT HOME
A FREE WELLNESS PROFILE (where we review health goals)
Who invited you to the workout?
*
Please Select
Kenia Smilez
Janelle Barclay
Friend
Dancewave
Online
My friend who invited me!
My Products
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VXN Membership
$60.00
$
60.00
BEST DEAL! Commit to your health goals and cardio dance workout with me every week and save $$!! PURCHASE START OF MONTH TO USE ENTIRE MONTH. Please Zelle or Venmo - @kenia.i.polanco@gmail.com or @Kenia-Smilez
Cash
$20.00
$
20.00
Note: when you book more than once class you save! See drop down menu. Please fill registration form & pay at beginning of class, thank you! :)
Color
Single class
Two classes
Three Classes
Four classes
Venmo
$20.00
$
20.00
Note: when you book more than once class you save! See drop down menu. Please send to Kenia-Smilez or use CELL: 646-919-9076
Color
Single class
Two classes
Three classes
Four classes
Total
$0.00
$
0.00
Payment Methods
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make your payment.
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