Gold Registration

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CLASS COORDINATORS: KATHY AND LEI JIN – 636-288-9563

Membership Year*

Class Session 6*

Dance Classes

Choose any classes that you would like to register for:

Available Classes–Session 6*

Friday 7-8 pm Gold American – Tango & Mambo

Friday 8-9 pm Open International – Waltz & Jive

Friday Classes

Price:

Dancer Information

Dancer Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Home Phone*

Mobile

Choose Your Skill Level*

Partner Information

YOU MUST PROVIDE YOUR OWN PARTNER FOR THE FRIDAY CLASSES.

First and Last name used to register your dance partner. **

First Last

*NOTE: Each Dancer still must be registered independently

Payment Information

Your Total

Choose Payment Method

Online (PayPal or Credit Card)

Mail In Check

If paying by credit card or check, you do not need to fill out the PayPal information. Continue scrolling down, past the ‘Pay with PayPal’ and ‘Log In’ button. At the bottom is the button ‘Pay with Debit or Credit Card’. Click on ‘Pay with Debit or Credit Card’. This will bring you to a page to fill out your credit or debit card information.

Please submit this form and mail your check:
Payable to: St. Louis Ballroom Dancers

Mail to:
Kathy and Lei Jin, 2111 Brook Ridge Drive, Chesterfield, MO 63017