Cairo Fusion Registration Form

  Name__________________________________________________  Age________  

  Mailing Address____________________________________________________________

  E-Mail Address_________________________________  Phone #____________________

 Have you taken dance classes before?  If so, what kind & how long?___________________

  _________________________________________________________________________

  Do you have any health issues we should know about?  (i.e. injuries, heart conditions, etc.)

  _________________________________________________________________________

  Are you pregnant?____________  How far along?____________________

  What are your goals with dance classes?  (please check all that apply)

  Performance _______            For Fun _______

  Exercise________  Other_________________________________

 Please check the class you would like to attend

  Intro to Cairo Fusion Basics________  $60/Month  1-1.5 hr. class weekly

  Gypsy Echoes-Intermediate Bellydance**______  $60/Month  1-1.5 hr. class weekly

  **This class requires Samira's  recommendation

  -Classes are filled on a first-come-first-served basis.  If class is filled, you will be notified when

  there is an opening.

  -All fees are due at the first class of each month.  Fees are non-refundable after the first class

  of each month. 

Mail to:  Samira, PO Box 50035, Boise, ID  83705

**DO NOT SEND MONEY NOW!**