Fields marked with an asterisk * denotes required information.
Daytime Phone*
Mobile Phone
Address
Date of Birth (dd/mm/year)
Preferred Contact Method
Choose option Email Phone
Registering For*
Hold down the CTRL KEY and click for multiple selections
Boot Camp Hens Night Enquiry Dance Workshops Dance Coaching Beginner Dance Courses Team Building Private Group Classes Performance Courses Casual Dance Classes
Other (please specify)
Start Date of Course or Class* (dd/mm/year)
How Many People?
Preferred Payment Method*
Choose option Credit Card Internet Banking Manual Bank Deposit Money Order/Bank Cheque Cash
How did you find us?*
Choose option Dance Central Latin Dance Australia Dance Network web site Yahoo MSN Google Friend Other Search Engine 9 to 5 Magazine Sydney Morning Herald Newspaper RSVP Events 4 Singles Prodance web site Other Web Site Sydney Central Newspaper
Receive monthly Special Offers email?
Yes please (If No, uncheck)
What other dance styles would you like to try?
Hold the CTRL KEY and click mouse for multiple selections
Latin Hip Hop Bollywood Jazz Technique Stretching and Flexibility Popping/Locking Flamenco Tap Dance Polynesian Hula Belly Dancing Breakdancing Burlesque (Sexy Moves for Women) Ballet Basics Dance Hall Brazilian Samba (no partner required) Salsa Styling (no partner required) Cha Cha Cha Styling (no partner required)
Personal Declaration
I understand there is a risk of personal injury associated with exercise. It is my responsibility to ensure that the people I am registering for including myself are medically fit to attend dance classes, workshops, coaching sessions, and team building activities. ACT SING DANCE Instructors take all reasonable care but are not responsible for loss of personal property or personal injury sustained during class.
I have read, understood and agree to these terms and conditions