Salsa Dance Lessons Registration Payor Name* First Last Student Name* First Last Student Age* Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code For lessons please submit the day and time that works best for you. The instructor will reach out with their open availability.* Choose your lesson duration30 Minutes45 Minutes60 MinutesLessons go from January 9th - May 6th (No class March 20-24)Payment information* I agree IMPORTANT: Payments only accepted by PayPal account. You will be automatically redirected to PayPal. Cash and checks not accepted. Total $0.00 NameThis field is for validation purposes and should be left unchanged.