Class Registration at Amira Dance Productions, in Wichita KS

Class Registration at Amira Dance Productions

Middle Eastern, American Tribal, Gypsy, Hula, East Indian & more.

Welcome to Amira's online class registration.

This form is to register for all ADP classes.
- Beginning and Intermediate classes
  - These classes are
    - 8 classes = $50.00 + $1.80 processing fee
    - 16 classes = $75.00 + $2.55 processing fee
  - Each class runs for a session of eight weeks and is paid per class.
- Advanced and Troupe classes
  - These classes are $50.00 + $1.80 processing fee/month.
  - Each class runs continuously, and is billed once a month on the first day of the month.
We offer discounts for multiple classes. Please complete this form and the liability agreement, then go to the request form for multiple classes. You will be sent an adjusted invoice which reflect your discounts.

Personal Information:
*First Name:	*Last Name:
*Street Address Line 1:
Street Address Line 2:
*City:	*State:	*Zip:
Home Phone:	Cell Phone:
Work Phone:	*Email Address:
*Date of Birth:	Date of First Class:

Medical Information:
Please give us any information regarding health that would be important for your instructor to know, i.e. Asthma, Diabetes, previous injuries, etc.

*Emergency Contact:	*Phone:
Doctor Name:	Doctor Phone:
Preferred Hospital:
Family information we should know about:

Items with a* are required.

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Amira Dance Productions, LLC 2008

Contact Webmaster • Maintenance by Jadzia

Last Updated : Saturday, February 23, 2008

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