Workshop Registration Form

 1. NAME OF STUDENT ________________________________ AGE ____________

circle one or both workshops below

2. Boost Your Nutrition with Laurie Wittenberg

      Alan Fox Workshop

3. CIRCLE ALL THAT APPLY:

           SOFT SHOE LEVEL

    BEGINNER      ADVANCED BEGINNER      NOVICE      PRIZEWINNER      CHAMPION

           HARD SHOE LEVEL

    BEGINNER      ADVANCED BEGINNER      NOVICE      PRIZEWINNER      CHAMPION

 3. DANCE WORKSHOP ATTENDING

• BEGINNER/ADVANCED BEGINNER

• NOVICE

• PRIZEWINNER/CHAMPION

 4. PAYMENT