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Detroit Male Dance Summer Intensive

Registration Form

First Name
Last Name
Date of Birth
Years of Dance Training
Street Address
ZIP Code
Cell Phone
Best Number At Which To Reach You
Parent/Guardian Name
Parent/Guardian's Phone Number
Emergency Contact Name
In addition to your parent/guardian, who should be contacted if there is an emergency?
Emergency Contact's Phone Number
I confirm that the information submitted in this form is true, accurate and complete.
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