Online LADD registration

 

Student information

 

First Name*

Middle Name

Last Name*

 

Male / Female*

Date of birth*

Adress*

 

City*

State/Province*

Zip/Postal

 

Home phone*

Cell Phone*

Email *

 

Speaking Languages*

Dance Studio of Origin*

Address Dance Studio*

 

City

State/Province

Zip/Postal

 

Dance Level*

T-shirt Size*

Where did you hear about us?*

 

Emergency Contact Information*

 

First Name*

Last Name

Relationship*

 

Home Address*

City*

State/Province*

 

E-mail*

Home Phone*

Cell Phone*

 

Program preference

 

Registration Deposit via bank wire : 500.00 US dollars

 

Package* BASIC PACKAGE DANCE PACKAGE LADD PACKAGE DELUXE PACKAGE

Period* WINTER - JANUARY 9/23 2013 SPRING - MARCH 27- APRIL 10 2013 SUMMER - AUGUST 3/22 2013

 

Duration* Choose Option 8 days 15 days 20 days 24 days

select single or group* Choose Option single student group 1 (room 2/3 people) group 2 (room 3/4 people)

 

name of the group or dance studio*

 

Name of the coordinator you are being in contact with: