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Application for DJ, Instructor, or Choreographer

Business Information

Name:   First   MI   Last
Street Address:   City:   State:
Zip Code: -   (+ 4 optional)                Phone: ( ) -
( DON'T show Address in Listing. )

Business Name:   Affiliations ( 2 max. ):
Email:        Website URL: http://www.
Your "Line Dance Message Board" Login Name (so I can upgrade your status and you can post in "Submit A Line Dance"):   
Category:                        Instructor          DJ          Choreographer
Other Specialties:            Instructor          DJ          Choreographer          Facility

Advertisement

Type ad here (max. 300 chs.):

Schedule

MONDAY
Hours:   AM PM     to        AM PM      Price: $ .
Location/Hall:    Street Address:
City:       State:   

TUESDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

WEDNESDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

THURSDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

FRIDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

SATURDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

SUNDAY
Hours:   AM PM     to        AM PM       Price: $ .
Location/Hall:    Street Address:
City:       State:   

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Please consider making a donation to New England Line Dance Resource. Your donation will help defer operating costs and allow me to bid on better keywords as well as to take advantage of other forms of publicity. Nothing is required, but help is always appreciated!


I would like to make a donation of (multiples of $5 only):   $

Please make Donations payable to:   TMS Dancer
c/o Teresa Schliker, 18 Mayflower Rd, Leicester, MA  01524.
(Check or money order only...please do not send cash.)