EAW Application

Which Session Are You Registering?
check one (or more!)June 3rd- 7th -John Cooper School AerialistsJuly 22nd- 26th
Date 00/00/0000
First Name
Last Name
Age
Cell Phone
Home Phone
Email Address
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
ABOUT ME
Please tell a little about yourself. Any Dance/Gymnastic training? Have you ever done Aerial Arts before? What are your goals? etc.
Parent or Guardian
Best Contact Number
Email Address
REFERRAL CODE (If you have one)
Electronic Signature Typing applicant's name will be considered as an electronic signature for all intents and purposes.
Pay with Paypal Secure payments are processed through PayPal. Click on logo (below) and follow instructions to send a payment to Elite Aerial WorX / Jill Crook using the email address: jill@eliteaerialworx.com. A confirmation email will be sent upon completion of the transaction. Thank you.
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