Full Name: ________________________________________

Date of birth:_______________________________________

Address and post code:______________________________

__________________________________________________

__________________________________________________

__________________________________________________

Telephone number:__________________________________

Email:  ____________________________________________

Do you have a disability? No  ____  Yes _____

If yes, please specify:____________________

     Please specify your employment status    ____________

Why would you like to be a volunteer and what do you hope to achieve?

Training

Work Experience

Other reasons, please state:__________________________

What kind of activities would you like to be involved in?

Dance teaching

Dance demonstrating

Dance performance

Music

Hospitality

Marketing and promotion

Administration

Multimedia for filming video and recording music

Other activities please state:

______________________________________

Equal Opportunities:                    

To help us see how our equal opportunities policy is working please specify which of these groups you belong to:

White caucasian ___   Black __   Asian___   Indian___ Mixed ___

                       Other description __________________________

REFERENCES:

In order for me to enrol you as a volunteer, I need two references from you. The first should be from a professional person who has known you for at least 6 months. This can mean a teacher, physiotherapist, doctor, lawyer, minister of religion, or any other professional. They should not be a member of your immediate family.The second referee should be a friend who has known you for at least 1 year.

Please send form to: Thomas Oflaherty, FLAT 45, BISMILLAH BUILDING, CONSTITUTION HILL, HOCKLEY BIRMINGHAM. B19 3LY.

Tel: 0121 233 9976      Email : spirit _ salsa @ yahoo. co.uk