------ TWO LEFT FEET DANCE ------ Beginner Friendly Dance Lessons

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Registration Form-Adults

Foxtrot - Waltz - Polka - Viennese Waltz - Disco - Swing - - Tango - Rumba - Bolero - Bosa Nova - - Salsa - Merengue - Mambo - Samba - Cha Cha Cha -
TWO LEFT FEET DANCE.com Two Left Feet Dance Studio 217 Market Street West Gaithersburg, MD 20878 In the Kentlands Market Square 301-346-2499 or 240-632-2345 Email: dance@twoleftfeetdance.com
REGISTRATION FORM Click & Highlight the section you want to copy & print. Check Selection as the page range for printing. To Register: Print a copy of this form. Fill out the information requested. Keep a copy for your records. We will e-mail a confirmation as a receipt of your registration. Please make your checks payable to TWO LEFT FEET DANCE. Send your check to 217 Market Street West, Gaithersburg, MD 20878. We also accept cash as a form of payment. We do not take credit cards. ADULT DANCE CLASS REGISTRATION FORM Name(s): _______________________________________________ Address: _______________________________________________ City: _________________ State: ________ Zip: _______ Home Phone: (_____)____________ HERS: Work Phone: (_____)_____________ Cell Phone: (_____)____________ E-mail: __________________________ HIS: Work Phone: (_____)___________ Cell Phone: (_____)___________ E-mail: __________________________ How did you learn about Two Left Feet? _________________________________________________________ GROUP CLASS DAY Circle: - MON - TUES - WED - THURS - FRI - SAT - TIME:_______ START DATE:___/___/_____ DANCES:______________________________________ FEE: Senior or Day $72/person for 6 classes _____ 12 Evening Group Classes: Adult Single $265 _____ Adult Couple $395 _____ 6 Sampler Group Classes: Adult Single $140 _____ Adult Couple $220_____ PRIVATE LESSONS Circle: - 1 - 3 - 6 - 12 - 24 - 48 - Circle: DAY or EVENING FEE: $__________ To receive quantity rated discount, fee must be paid in full. PRIVATE PARTY Date: ______/______/______ Time: ________ 1 hour = $270 (for two instructors)