Register Online for our Mother Daughter Dance!

Please provide the following contact information with name, email and at least one phone number

Name *
Contact Phone 1 *	Is this a cell, home, work?
Contact Phone 2	Is this a cell, home, work?
Contact Phone 3	Is this a cell, home, work?
E-mail *

Choose one of the following classes:
Fees will be charged as indicated. There are no refunds or credits for any reason if you or your guest cannot attend this class.
You and your guest must arrive 15 minutes early to sign a waiver.

Mother - Daughter Dance
Cost $25 for both yourself and your guest.
Saturday May 12th  Chicago Heights 11:00am class is full
Saturday May 12th  Chicago Heights 12:30pm
Saturday May 12th  Chicago Heights 2:00pm


 

Pay using your credit or debit card below:

All payments are non-refundable

Please provide the following billing information:

	Credit Card Type: Visa Mastercard American Express Discover *
Name On Card *
Account Number *
Expiration Date *	4 digits 00/00
CVS Code *

	Billing Address (No PO Boxes)
Street Address *
Address (cont.) *
City *
State/Province *
Zip/Postal Code *
Country

The following box must be checked or this registration will not be processed.*

I certify that the above information is correct. I understand that registration for class cannot be cancelled and payments are non-refundable and no credits given I understand that all group classes are for women only. Neither I nor my guest are pregnant and do not have any medical conditions which would preclude us from taking this class. I also verify that the above credit card information is my own and that I and my guests are at least 18 years of age.