Dance Inquiry

Full Name:
Work Phone:
Home Phone:
Cell Phone:
E-mail: * required
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Sex:	Female Male
	What type of lessons are you interested in?
	Private Group

	What dances are you interested in?
	Latin Salsa Mambo Rumba Cha Cha Merengue Bolero Samba Cumbia Bachata	Ballroom Foxtrot Waltz Tango
	Swing Whip West Coast Swing Swing Jitterbug Country Swing	Misc Wedding Club Slow Dancing Belly Dancing Hip Hop
	Country Western Two Step Polka Nightclub Waltz Line Dancing Other Dances:
	How many people?
	Which Day could you take lessons? MON.    TUE.    WED.    THU. FRI.    SAT.    SUN.
	Select any of the following options that apply: Morning   Afternoon   Evening
	Your height?
	How did you hear about us? Yellow Pages Referral/Friend Web Search Another Web Site Other
	What is your level of experience as a dancer? None Beginner Intermediate Advanced
	If you found us by using a search engine, please tell us which one: None Google Bing Yahoo Yelp Ask AOL Facebook Other
	Please add any additional comments below.