Western Square Dance Class Interest Form

Fill in the following fields and click "Send Email to Class Committee."
By submitting this form I am declaring my interest in taking Western Square Dance Classes.
I would like to be contacted to discusses class availability with dates, times, and cost information.


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* Required Fields
Your Name: *
Your Email Address: *
Your Email Address:
Enter Again for verification.		 *
Your Phone Number:
Contact Preference?
  Phone    Email *
Reason for this Inquiry?
 *
 I am ready to take classes that teach Western Square Dancing
 I am seeking more information about Classes that Teach Western Square Dancing
 Other Reason
If Other, Please enter your reason for inquiry:
About you?
I have prior Square Dance Experience
  Yes    No *


 I would be a single dancer with no partner to bring to Class
 I have a partner to bring to class

If you have a Partner:
My Parter has prior Square Dance Experience

 Yes    No *
If you have a Partner:
Partner Name:
*

 Partner Email Same as Above
 Partner Email is Different than above
Enter Partner Email here if different than above (optional)

 Partner Phone Same as Above
 Partner Phone is Different than above
Enter Partner Phone here if different than above (optional)
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