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 Your Skill Level * Novice Skilled Choose any Novice Classes that you would like to register for * Thursday 7-8PM - Introductory Social Dance FOX TROT • TRIPLE SWING Thursday 8-9PM - Intermediate Social Dance WALTZ • RUMBA Thursday 9-10PM - Pre-Silver WALTZ • CHA CHA Choose any Skilled Classes that you would like to register for * Tuesday 7-8PM - Silver VIENNESE WALTZ • RUMBA Tuesday 8-9PM - International Silver WALTZ • CHA CHA Friday 7-8PM - Gold American FOX TROT • MAMBO Friday 8-9PM Gold International Open QUICK STEP • RUMBA 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 Check via Postal Mail NOTE: If paying by credit/debit card, you do not need a PayPal account to proceed. On the following payment screen, just click the link as shown highlighted in the picture below with the red arrow.