Registration













 

Registration Form

Please print out this form and mail it with your payment. Thank you!

Mark your calendar. Confirmations will not be sent.

PLEASE READ REFUND POLICY.

Mail to: Ninth Street Dance, 1920 1/2 Perry Street, Durham, NC 27705

Name____________________________________ Age (if child)________________

Address_______________________________________________________________

City/State__________________________________ Zip________________________

Phone (home)_____________________ (cell)______________________________

E-mail address__________________________________________ Date __________

I am registering for:

 Class

Day & Time

Fee

_____________________

_____________________

_____________________

_____________________

_____________________

_____________________

_____________________

_____________________

_____________________

Date___________________ Amount of payment enclosed $ ______________________

Paying by Credit Card? _____ Visa _____ MasterCard

Card Number______________________________ Expiration date ________________

Name as it appears on card________________________________________________

Cardholder's signature___________________________________________________