Michael Blevins' 2012 Summer Dance
1st Student Name:
2nd Student Name:
3rd Sibling Name:
Parent Name:
Regularly Checked Email:
Phone Number:
Address Line 1:
Address Line 2:
City:
State/Province:
Country:
Zip/Postal Code:
Dates Student/s Will Attend:
June 23 24
June 30 July 1
July 7 8
1st Student Workshop Choice:
Dance Acting Combo
Dance Only
Acting Only
1st Student Dance Level:
Trk 1
Trk 2
Trk 3
1st Student Acting Level
Acting 1
Acting 2
2nd Student Workshop Choice:
Dance Acting Combo
Dance Only
Acting Only
2nd Student Dance Level
Trk 1
Trk 2
Trk 3
2nd Student Acting Level:
Acting 1
Acting 2
3rd Sibling Workshop Choice:
Dance Acting Combo
Dance Only
Acting Only
3rd Sibling Dance Level:
Trk 1
Trk 2
Trk 3
3rd Sibling Acting Level:
Acting 1
Acting 2
Total Tuition Amt for All Students:
Payment Method:
Online Payment
Mail In Payment
Comments/Speical Instructions: