Name     

Address  

City    Zip Code 

Home Phone   Cell Phone  

Wk. Phone   Reachable Home Cell Work

Email address

What type of dancing do you do now or what are your goals for your dancing?

 Are you familiar with the following dances?

Fox-trotWaltz  Swing  Rumba    Polka  Mambo

  Tango  Samba  Cha Cha    Merengue    Push

  CW 2-Step    CW 3-Step    CW Shuffle    CW Waltz

 

How did you find out about our studio:

   Telephone Book    Democrat    Shopper    Friend/Family

   Flyer    Business Card    Internet 

Sign (type)   

 

Would you be interested in any of the following dance activities?

Group lessons in

Ballroom Country Western Latin   Swing

Studio parties (1^st Sat. night of each month) Select Yes NO

Friday night parties in Ft. Worth  Select Yes NO