Delightful Dance Social Dance Instruction
	Join life instead of being a spectator.

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Class Name

Other Class

Class Level

Class start Date & Time

Amount per person for class series $

First Name

Last Name

Birthday Month Day Year

Height This is to assist matching up singles with partners when possible.

Home Phone

Work Phone

Cellular Phone

E-Mail

Mailing Address

City

State

Zip

Attending with - Partner's Name (First and Last)

Remember your Partner need to fill out a separate form.

 Comments/Questions

Warning/Release: You are advised to consult your physician before beginning this or any other dance program or activity. The author, producers, performers, instructors and/or distributors disclaim any liability for losses or injuries sustained in connection with any advice, activity or demonstration contained herein or at any event, party, dance, workshop, class, or demonstration.

By submitting my registration I acknowledge that I have read and accept the above warning/release.

REGISTRATION FORM (push submit only once please). You will not get an auto response. I will respond personally within a few days. Miss Lori