Print Contact Form

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}