REGISTRATION FORM

Sam Ray Brazilian and Latin Dance Programs

SAMBA DANCE LESSONS  "Original Brazilian Freestyle"

Basics:|___ Group:|___  Beginner:|___  *Intermediate:|___ 
Semi-Private:|___  Private:|___ 

*Intermediate - Builds on Samba Basics with emphasis on technique/expression/choreography
(6 mos. Latin or Ballroom or completion of Samba Dance Basics required).
   

Course Fee: $_______ Session(s):____ Weekday:________ Time:_______

Start Date:___/___/___   End Date___/___/___

Location:______________________________________________________

Name _________________________________________________________

Address _______________________________________________________

City/State/ZIP __________________________________________________

Phone (H)______________________ (W)____________________________

E-mail ______________________________________

Signature ____________________ Date ___________

BY MAIL - Please, print it, fill in form and mail payment to Sam Ray at

Sam Ray Dance Programs
P.O. Box 390772 – Cambridge, MA 02139

ON-LINE @ WWW.SAMRAY.COM

Register early as class size limited to 20 students.

Check class availability or place yourself on waiting list.

Please send any question to samba@samray.com