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First Name *

Last Name *

Email Address *

Phone *

Your City and State *

How far are you willing to drive to meet your instructor *0-5 miles0-10 miles0-15 miles0-20 milesOver 20 miles

This lesson is for a *ManWomanCouple

Age group *3-78-1213-1718-3536-5051-6566-80Over 80

Your Dance Level *Newcomer - Never had dance lessons beforeBeginner - Had some dance lessons long time agoIntermediate - Feel comfortable dancing, but could use a refresherAdvanced - Been dancing for years

Style (s) of dance interested *

International Latin - Chacha, Samba, Rumba, Pasodoble, JiveInternational Ballroom - Waltz, Tango, Viennese waltz, Foxtrot, QuickstepAmerican Rhythm - Chacha, Rumba, E.C.Swing, Bolero, MamboAmerican Smooth - Waltz, Tango, Foxtrot, Viennese waltz, PeabodyClub Dances - Argentine Tango, Bachata, Country 2-step, Hustle, Merengue, Salsa, W.C.Swing,Others

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