Belly Dance Basics DVD

Student Registration For All Class Offerings

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Name:*

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Class Choice:

Beginner & Open Level w/Jess - Saturday 10am - 11am Class Card: 3 minimum at $10 per class (no expiration date) or $15 per lesson (drop in) Basic Fundamentals w/Gypsy- Wednesday 6-7pm; $60 per six-week session -or- $15 per lesson Troupe Class w/Gypsy (by invitation) - Wednesday 7-8pm; $60 per six-week session -or- $15 per lesson

Do you agree to the above terms?*

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Children:

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Pets:

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Any past dance or theater experience or training?

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If Yes, please describe:

Do you play any musical instruments?

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If Yes, please describe:

Do you have any physical constraints, illnesses or past injuries? If yes, please list below:

How did you hear about my class and/or web site? yellow pages, internet search, newspaper/magazine ad. If referred by friend please list name):

Do you have any concerns or questions?

Are you interested in continuing lessons and perhaps joining a troupe?

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Don't Know

Please confirm Beginner Basics session (beginning date) for which you are registering:

Gypsy (Wednesday): January 11, 18, 25; February 1, 8, 15
Jess (Saturday): to be announced

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Payment Option

Beginner 4-Weeks/Month $50.00 USDPer Lesson $15.00 USDPrivate Lesson $65.00 USD