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PROGRAM REGISTRATION FORM
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FIRST NAME | PRIMER NOMBRE
*
Your answer
LAST NAME | APELLIDO
*
Your answer
DATE OF BIRTH | FECHA DE NACIMIENTO
*
MM
/
DD
/
YYYY
EMAIL | CORREO ELECTRONICO
*
Your answer
PHONE NUMBER | NUMERO TELEFONICO
*
Your answer
CITY | CUIDAD
*
Your answer
STATE | ESTADO
*
Your answer
ZIP CODE | CODIGO POSTAL
*
Your answer
NEW OR RETURNING | NUEVO O DE ANTES
*
New Participant/Participante Nuevo
Returning Participant/Participante de antes
GENDER | GENERO
*
Male | Masculino
Female | Femenino
Do not wish to respond
PROGRAMS AND ACTIVITIES | PROGRAMAS Y ACTIVIDADES
*
CREATIVE ARTS WORKSHOPS
FOLK DANCE WORKSHOP
ADULTS SALSA & BACHATA
KIDS SALSA & BACHATA
PERCUSSION WORKSHOPS
WANT TO JOIN THE MAILING LIST
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