Registration Form
Spring 2004 Semester

Jazz Moves
4830-104A Street
Edmonton AB T6H 5Z1

Contact us at: [email protected].

Early Bird Deadline is March 31. Registration Deadline is April 9, 2003.

Name:____________________________________________

Address:_________________________________________

Postal Code:__________________ Phone_____________

E-mail: _________________________________________

Please register me for:

Wed. Beginner Jazz (10 wks)	_____ Early Bird $110.00 (before March 31)	_____ Regular $120.00
Wed. Int/Adv Jazz (10 wks)	_____ Early Bird $145.00 (before March 31)	_____ Regular $160.00
Sun. Hip Hop Beginner (8 wks)	_____ Early Bird $88.00 (before March 31)	_____ Regular $96.00
Sun. Hip Hop Experienced (8 wks)	_____ Early Bird $88.00 (before March 31)	_____ Regular $96.00

Amount Enclosed (payable to Jazz Moves)$_______

How Did you Hear About our classes?
_____ Friend/Word of Mouth
_____ E-mail
_____ Yellow Pages
_____ Campus Rec Guide
_____ Theatre Alberta Ad
_____ Previous Jazz Moves Student
_____ At Orchesis Modern Classes
_____ Posters on Campus
_____ See/Vue Magazine
_____ Internet (pls specify search engine and key words)

_____________________________________________

Mail completed form along with payment to:
Jazz Moves
4830-104A Street
Edmonton AB T6H 5Z1

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