Class Registration St. Louis Ballroom Dancers Registration Form Dancer Information First Name * Last Name * Address * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zipcode * Email Address * Home Phone Number Mobile Number Is anyone in your household a member for the current year? * Yes No Dance Classes Choose any Novice Classes that you would like to register for * Thursday 7-8PM - Introductory Social Dance FOX TROT • CHA CHA Thursday 8-9PM - Intermediate Social WALTZ • RUMBA Thursday 9-10PM Pre-Silver QUICK STEP • BOLERO Choose Your Skill Level * Novice Skilled Choose any Skilled Classes that you would like to register for * Tuesday 7-8PM - Silver American FOX TROT • CHA CHA Tuesday 8-9PM - International Silver WALTZ • JIVE Friday 7-8PM - Gold American VIENNESE WALTZ • NITE CLUB TWO STEP Friday 8-9PM - Open International WALTZ • CHA CHA Do you need a partner to be provided for you? * Yes No First and Last name used to register your dance partner. * *NOTE: Each Dancer still must be registered independently NOTE: For the Skilled classes, partners are REQUIRED. If you do not have a partner already, please stop registering and EMAIL: firstname.lastname@example.org to make arrangements prior to registering. NOTE: For the 9:00PM class, partners are REQUIRED. If you do not have a partner already, please stop registering and EMAIL: email@example.com to make arrangements prior to registering. We Announce Member Anniversaries and Birthdays in our Newsletter Enter your Anniversary and Birthday if you would like to be recognized in our Newsletter. (optional) Anniversary Date Birthdate Payment Details Total Amount * Choose Payment Method * Credit/Debit Card via Paypal PayPal Check via Mail NOTE: If paying by credit/debit card, you do not need a PayPal account to proceed. Click on the 'Submit' button below to get to the payment type screen. If paying by credit card, you do not need to fill out the PayPal information. Continue scrolling to botton of page and click on Pay with Debit or Credit Card. This will bring you to a page to fill out your credit or debit card information.