Class Listing Form 1008

Class Listing Form

This form MUST be received by the 25th of the month. Two months prior to the beginning of the class. I. E. July 25th for the September issue. Classes can be listed for three months when submitted on separate forms.

ROUNDUP issue (month / year):		Club Name:
Region:
Starting Date (date of the first lesson in this series):

Check the appropriate items below:

Day of the week	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Week(s) of the Month	1	2	3	4	5	Every

Check the highest level to be taught:

Round Dance Level	I	II	III	IV	V	Classics
Square Dance Level	Basic	Mainstream	PLUS	A1	A2	C1	C2
Country / Western Dance Form	Two Step		Three Step		Line		Swing
Folk Dance Level	Beginner		Beginner II		Intermediate		Advanced
Caller / Leader / Instructor:
Contact Information:

Submittied By:

Name:
Address:
City / State / Zip Code:
Phone Number (with area code):
Email Address: