>DISTANCE LEARNING COURSE REGISTRATION

Name:


Address:


City, State, ZIP:


Phone:


Fax:


E-mail (please provide your personal email address as well as your school/work email address):


Profession/Organization:


Dance Experience:


How did you learn about our distance learning course:


Are you taking this course for college credit / independent study:


Name of the university/college:


Advisor and contact information (email and phone number):


Or other reasons:

Please enroll me in the following distance learning course:

____ Elementary $605
____ Intermediate $650

Students outside the U.S. or Canada must add $55 to the fee to cover additional postage. Full payment in U.S. dollars must be received before course materials will be sent.

Please mail completed form and payment to:

Dance Notation Bureau
111 John Street, Suite 704
New York, NY 10038