First Name		Last Name
Street Address		City, State, Zip
Best Time To Call		Phone Number:
Alternate Phone Number:		E-Mail Address:
Availability For Class:	Afternoons Evenings Either	Do you know anybody currently in our program?	Yes No If yes, name?
Are you preparing for an event?	Yes No	If so, please descirbe the event:
Dance Style Interes (check all that apply)	Fox Trot Tango Waltz Swing Cha-Cha Salsa Samba Merengue Mambo Rumba WC Swing Hustle Argentine Tango Lindy Hop Bolero Country Viennese Waltz General Variety Other
Additional Information