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Name: __________________________________ Phone: _________________________ Address: ________________________________________________________ City: _____________________________________ State: _______ Zip: ___________ Email address: _________________________________________ Name of Class or or Workshop: _______________________________ Date: _____________ Total Amount enclosed: _________________ Your Check number: ___________ Please make your check payable to: Swing Danceworks, LLC and mail your check with this form to P.O. Box 244, Marlborough, CT 06447. If you would like to repeat a "Jitterbug Jane" class, please send Jane an email to verify status and discount. |