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CREATIVE DANCE WORKSHOP
October 7, 2006
REGISTRATION
Directions & Confirmation
will be sent upon receipt of payment
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
NAME: _________________________________________

PHONE: ________________________________________

EMAIL:_____________________________

MAILING ADDRESS:
Street wt number or PO: ____________________________________________________

City: ________________________ State: ______________ Zip: ___________


Creative Dance Tuition...$50.00

Enclosed is my non-refundable deposit ($25.00) ________
Or
Enclosed is the full tuition (enter amount) ________

Balance due (enter amount) ________