CPDW Spring 2020 Registration

Spring 2020 Registration
Central Pennsylvania Dance Workshop
- Full Name
  First NameLast Name
- Address
  Street Address
  Street Address Line 2
  CityState / Province
  Postal / Zip Code
- E-mail
- Contact Number
  Area CodePhone Number
- Age
- Birthdate
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Grade
- Parent/Guardian
- Emergency Contact
- My classes
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  #500 Adult Beginning Ballet, M/W 7:30pm - 8:45pm$378.00
  
  #501 Adult Beginning Ballet Workout, M/W 10:30am - 11:45am$369.00
  
  Insurance fee$10.00
  
  Enter coupon
  
  Total $0.00
  Credit Card
- Billing Address
  Street Address
  Street Address Line 2
  CityState / Province
  Postal / Zip CodeCountry
- Additional Requests
- Should be Empty: