September 8, 2007 Registration | |
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Any questions? Phone 401-521-0546 Email doug.dance@juno.com |
Print out this form and mail with check (made out to Doug Victor) to: Doug Victor 103 Princeton Avenue Providence, RI 02907 |
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NAME: _________________________________________ PHONE: ________________________________________ EMAIL:_____________________________ MAILING ADDRESS: Street wt number or PO: ____________________________________________________ City: ________________________ State: ______________ Zip: ___________ September 8, 2007 $60.00 ________ Enclosed is my non-refundable deposit ($25.00) ________ Enclosed is the full tuition (enter amount) ________ Balance due (enter amount) ________ | |