Registration | Penrith Ballroom Dance

Date*

Enter the date of your Order.

Order #*

Enter the number displayed after # on the previous screen & in the Order Summary sent to you via email.

Select your purchase.*

Select the class, lesson, package or combination of any you have purchased.

Participant's Name*

First Last

If a couple, 2nd participant's name

First Last

Date of Wedding

DOB

Required only if participant is under 18.

Parent or Guardian name

Required only if participant is under 18.

Known conditions

Required only if participant is under 18. Please disclose any condition your child may have and which we should be aware.

Purchaser name*

Enter the name of the person making the purchase.

Mobile phone*

Other phone

Email*

How did you pay for class?*

How did you hear about Penrith Ballroom Dance?*

Terms & Conditions*

I have read and agree to the published Terms and Conditions.

CAPTCHA

Details required for Gift Certificate preparation

Gift Certificate from*

Name of person giving the certificate.

Gift Certificate to*

Name of person receiving the certificate.

Gift Certicate reason*

Enter reason or occasion for certificate purchase.

Additional comments

Do you have any questions or comments for us?