London Diary Ltd United Kingdom
Group of Dance Classes Affiliated
Dance Lessons Programme Form
Promoting Professional Safe Dance Lessons

 Fields marker with an * must be completed!


This form is just to confirm your interest in becoming an
affiliation member of London Diary Ltd Dance Class
Programme and not a confirmation of your membership.
 We will contact to confirm your subscription and request payment details once you have been accepted.
 
Title:*
Your First name:*
Your Surname:*
Your Company Name:
Address Line 1:*
Address Line 2:
Town/City:*
County/Province:*
Post Code:*
Mobile Tel:*
Land line Tel:
E-Mail Address:*
Affiliation level & cost:*
Gold club £15 a week
Corporate £20 a week
If accepted do you agree to pay 52 weekly instalments by debit/credit card* Yes No
Amount to Pay:*
Subscription Type:*
Do you or the dance teacher/s hold a qualified dance certificate from the UKA or IDTA: Yes No
Comment:

    
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