Date *

MM

DD

YYYY

Division *

Junior ( 15 - 17 )

Name of Dancer *

First Name

Last Name

Gender of Dancer *

Male

Female

Date of Birth of Dancer *

MM

DD

YYYY

Phone Number of Dancer *

Country

(###)

###

####

Name of Coach *

First Name

Last Name

Phone Number of Coach *

Country

(###)

###

####

Name of Partner *

Note** If doing Classical Solo Variation please type NA in both boxes.

First Name

Last Name

I have read and understood the VKIBC rules and regulations *

Yes

Payment Method *

Note** This form will not be considered valid unless payment is made. If paying with PayPal or credit card, please scroll down and select Add To Cart. If paying with U.S. check, please make it to the order of VKDF and mail to: VKDF, 1725 York Avenue, Suite 10A, NYC, NY 10128. If paying via Wire Transfer, please see the info at the bottom of the page.

PayPal or credit card

U.S. Check

Wire Transfer

How did you hear about VKIBC? *

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Friend

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Other