(Print & mail form or email same information with your check. Thanks)
Keith Stevens 4356 Ashton Club Dr. Lake Wales FL 33859
Email is the preferred method of communication.
PLEASE PRINT CLEARLY
Dancer # 1: _____________________________________
Street Address: _____________________________
City/State: _____________________ Zip _________
Tel #___________________
Email: _______________________________________
Dancer # 2: _____________________________________
Street Address: ________________________________
Cit/State: ___________________________Zip _________
Tel #___________________
Email: __________________________________________
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