Enrolment Form

Simply complete the form below (we've tried to keep the questions to a minimum). Don't worry - we won't share your details with any other third party. We hate spam as much as you do!

Personal Information

* Name :

 

Address :

 

Date of Birth :

 

 

Gender :

MaleFemale

 

Contact Details

* Email :

(MUST BE COMPLETED in order to receive confirmation of your place on the course and info on events and opportunities)

 

Day Telephone :

 

Evening Telephone :

 

Mobile :

 

Enrolment Details

Area :

IlfordFinchleyHarrowHatch EndCroydonKingsburySouthallSeven Kings

 

Please Specify :

 

Course :

Modern Indian (Bollywood)BhangraProfessional PerformancesOther

 

Please Specify :

 

Age Group :

4-7 Yrs8-12 Yrs13-adults YrsAll Ages Yrs

 

* Day :

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

 

Time :

 

Stage :

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(Each stage refers to a 3 month course currently under taken)

 

Payment Details

Membership Required :

SILVER MEMBERSHIP

GOLD MEMBERSHIP

PLATINUM MEMBERSHIP

 

Term Time :

September

 

Please Specify :

 

Fees Payable

FEES	SILVER MEMBERSHIP	GOLD MEMBERSHIP	PLATINUM MEMBERSHIP
Total Course Fees	£90	£249	£360

Payment Method :

CashCredit CardCheque - Payable to Global Performing Arts LtdPOOther

 

Please Specify :

 

Payment Mode :

I will call Honey's Dance AcademyPlease call me to take payment

 

How & Where Did You Hear of The Course :

TVNewspaperFriend Or FamilyInternetExhibitionWorkshopsRadioMagazineExisting MemberShow/EventOther

 

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Picture :

 

 

The picture contains 6 characters.

 

* Characters :

 

 I have read and understood the rules, regulations and procedures.