Enlightenment Through Dance Company
Class Registration Form*
Please use your browser's [Print] controls to print this page, then fill in and mail to the address below.
Full name:  
Dance name:  
Street Address:  
City/State/Zip   Country:
Telephone & best time to call:   email:
Please indicate your amount of payment:

Class  _____

Workshop  _____

Other event  _____

ED Teacher's Discount  _____
 
Enclosed: Check   Money order            Amount Total:_____________________
I have already paid via PayPal- Copy of receipt attached.   Amount:_____________________
Activities Release: I take responsibility for my Physical well-being. I represent that I am Physically and Mentally able to take Enlightenment Through Dance classes, workshops and to dance or participate on any event. I release Enlightenment Through Dance Company, Rosane Gibson and any other sponsors or representatives and successors from all claims or liabilities arising out of my participation in any sponsored activity.

Signed: ______________________________________________________    Date: __________________

Please make check or money order payable to
Enlightenment Through Dance Company and send to

Enlightenment Through Dance Company
1756 N Bayshore Dr apt 25G
Miami, FL 33132


Phone 863- 585-8264   email:
enlightendance@aol.com

 

*For Winter Haven Monday classes, enrollment must be done at the Civic Center