To enroll in the Bronze American Style Teacher Training Class

1. Fill out and submit this form.

2. Send your non-refundable $100 deposit to Valley Social Dance Studio (1331 W. Wisconsin Ave. Appleton, WI  54914)

Smooth (June 1-September 25, 2008)

Rhythm I (September 29, 2008-January 22, 2009)

Rhythm II (January 26-May 21, 2009)

Night Club (May 25-September 17, 2009)

First Name:      

Last Name:       

Address 1:        

Address 2:        

City:                

State:              

Zip/Postal Code:

Home Phone:   

Work Phone:    

Email:             

How did you hear about us? Yellow Pages Newspaper Radio T.V. Coupon/Certificate Drive Past Friend Internet Other

If other, please specify:

Please tell me about your dance background, if any.

What is your main purpose in taking this course?

Are you interested in pursuing a career as a ballroom dance teacher?  If so, why?

Please provide any additional information you think I should know about you.

Please send a non-refundable $100 deposit

You will receive a call or email to confirm receipt of your enrollment form and deposit.

Payment in full is due NO LATER THAN THE FIRST DAY OF CLASS

Please check one of the following:

I will call (920)731-4441 to make my payment by MasterCard or VISA

I have sent a check or money order, payable to Valley Social Dance Studio to 1331 W. Wisconsin Ave. Appleton, WI  54914