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Language Course Application Form

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SUMMARY

 

 

 

SECTION 1. PERSONAL DETAILS

 

INSTRUCTIONS

 
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Print out the application form, fill it in and enclose the evaluation from your present dance teacher and any other particular requests or objectives. This documentation can be sent either by e-mail , post, or fax. Please answer all questions. All fields marked with a * are required and must be completed. Applications must be received at least 4 weeks prior to the start of the course to guarantee the best seats for the performances and placement in the dance school chosen.

Once your application has been received you will be give a reference N that you will need to quote on all correspondence, e-mails or when contacting us by telephone.

Print out the credit card form and fax it to us on:+44 (0)870 1689892 together with the application form. For your convenience if you prefer, you can send us your application form securely on-line. We also accept credit card payment over the phone, cheques and bank transfers.

First Name*

Last Name*

Age:*

Passport N *

Home Tel N (country code first)

Work Tel N (country code first)

Mobile Tel N (country code first)

Fax N (country code first)

E-mail

Address:*

 

 

 

Next of kin Address and Tel N (if different from above)

 

 

 

Starting date:* (please tick)

4th January

2nd February

4th May

7th June

6th July

2nd August

7th September

 

Choice of dance school:* (please tick)

Alvin Ailey:

Erik Hawkins:

Jose Limon:

Lynn Simson Jazz School:

Joffrey Ballet School:

Mercie Cunningham:

Marha Graham:

I have studied the following dance styles:* (please state dates and weekly frequency of classes attended)

 

 

 

 

 

 

I have decided to register for this course because:*

How did you find our website?*  Please quote Ref N if applicable:

 

Contact address in New York:*

 

 

 

Contact telephone number in New York:*

SECTION 4. PAYMENT DETAILS

Pay to:

Totalnannies.com

Payment for:

Agency Fee for dance program in

 New York

Amount:

99.00

Payment for:

Registration Fee

Amount:

172.00

Total due:

271.00

I wish to pay for the registration fee by (please tick)

 Credit Card:    Bank Transfer:    Cheque: 

 

Declaration of Responsibility

 

I declare that I will not hold Dance Forum or any other

member of the teaching staff responsible for injuries

sustained or illnesses contracted by me whilst I am a

student at the Dance Forum or another dance school included

 in the Dance/English Program

Signed:

Date:

 

OTHER PROGRAM IN NEW YORK

 

S001/USA

 

Great Britian

France

 

Germany

Ireland

 

Italy

 

 

 

Great Britain

France

 

Germany

Ireland

 

Italy

 

 

 

 

 

 

 

 

 

Spain

Switzerland

 

USA

Japan

 

 

 

Spain

Switzerland

 

USA

Japan

 

 

 

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