TWO LEFT FEET DANCE.com
Two Left Feet Dance Studio
217 Market Street West, Gaithersburg 20878
in the Kentlands Market Square
301-346-2499 or 240-632-2345
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REGISTRATION FORM
To register : Print a copy of this form & fill out the information requested.
Keep a copy for your records.
We will e-mail a confirmation as a receipt of your registration.
Please make your checks payable to TWO LEFT FEET DANCE.
Send your check to 217 Market Street West, Gaithersburg, MD 20878.
We also accept cash as a form of payment. We do not take credit cards.
ADULT DANCE CLASS REGISTRATION FORM
Name(s):____________________________________________________
Address:____________________________________________________
City:____________________State:__________________Zip:__________
Home Phone:(____)________________E-mail______________________
Work Phone Hers:(____)_____________Cell Hers:(____)_______________
Work Phone His:(____)_____________Cell His:(____)_______________
GROUP CLASS DAY Circle: MON TUES WED THUR FRI SAT
CLASS Time: ________ Dances:______________________
FEE: Senior or Day $72____ Adult Single $265_____ Adult Cpl $395_____
(Please include and mail in any discount certificates you may have with this registration form.)
PRIVATE LESSONS Circle: 1 3 6 12 24 48
FEE:$________ To receive quantity rated discount, fee must be paid in full.
PRIVATE PARTY: Date:_____/_____/_____ Time:________
1 hour $270_____
1 1/2 hour $405_____
2 hours $540_____
How did you learn about Two Left Feet?_______________________________
