Lindy Hop & Swing Classes: September-October 2011 Session Registration Form

Name
eg: Alex Smith
Use separate submission for each person.
Email Address
eg: asmith@aol.com
If you do not have email be sure to provide a telephone number below.
Telephone
eg: 508–555–1234x56
eg: 508–555–1234
eg: 508–555–1234
Sunday Newton Classes
September 11–October 16, 2011
 (4:40–5:40pm)
(5:50–6:50pm)
(7:00–8:00pm)
Monday Boston Classes
September 12–October 17, 2011
 (6:30–7:30pm)
(8:00–9:00pm)
Cost per person
Discounts are for the same person taking multiple classes in the same session.
 Any one 6 week class (covers 6 weeks of lessons) $65
$55
$55
Any two 6 week classes $110
Any three 6 week classes $155
Any four 6 week classes $200
Total Amount
Role
Where you heard of us
Status
If you are not already on our mailing list complete the following fields.
If your address is already on our mailing list skip the following fields.
If your address has changed complete the following fields.
If same address as another person already registered, just note their name in the Comments section below and skip the following fields.
Extra line for address, leave blank if not needed.
Street
Town
State
eg MA
ZIP
Comments
Verification Code
9421
Used to help prevent SPAM-Bot submissions.
Submit Registration Information