Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Which dance genres have you taught before, please indicate all below: *

Tap

Ballet

Jazz

Tumbling

Lyrical

Hip Hop

Contemporary

Modern

Musical Theatre

N/A

Please indicate which level you have taught classes listed above: (select all that apply): *

Beginner

Intermediate

Advance

N/A

Supervisors Contact Phone Number *

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