MAIL-IN or FAX REGISTRATION FORM

SELECT your classes(es) and Organization(s), then CHOOSE one of these 3 EASY ways to Register:

(1) PRINT THIS PAGE, detach your Registration Form below & fill one out for each dancer.

(2) FAX REGISTRATION - Fax your Registration Form to the correct Sponsoring Organization with your Discover/MC/Visa card # and your expiration Date !

or (3) MAIL REGISTRATION - Mail your Registration Form to the correct Sponsoring Organization with your credit card information or check payable to that Organization !

For JIM'S CLASSES in:

GLASTONBURY CT, mail to Glastonbury Family YMCA, 9 Welles St., Fox Run Mall, Glastonbury, CT 06033 (Tel. 860.633.6548)

GRANBY CT, mail to Granby Recreation Dept., 15C N. Granby Rd., Granby, CT 06035 (Tel. 860.844.5356)

HEBRON, LEBANON & WILLIMANTIC CT, mail / fax to EASTCONN Northeast Learning Center, 111 Connecticut Mills Ave., Danielson, CT 06239 (Tel. 860.779.3770, Fax. 860.779.3384)

MIDDLETOWN CT, mail to Middletown Adult Education, 398 Main St., Middletown, CT 06457 (Tel. 860.343.6044)

OLD SAYBROOK CT, mail to Old Saybrook Adult Education, 1111 Boston Post Rd., Old Saybrook, CT 06475 (Tel. 860.388.1240)

SOUTHBURY CT, mail to Jewish Federation of Western Ct, 444 Main St. N., Southbury, CT 06488 (Tel. 203.267.3177)

WATERBURY CT, mail to Waterbury Adult Education, 28 E. Clay St., Waterbury, CT 06706 (Tel. 203.574.8038)

WATERTOWN CT, mail to Watertown Recreation Department, 51 Depot St. Suite 108, Watertown, CT 06795 (Tel. 860.945.5246)

WEST HARTFORD CT, mail / fax to West Hartford Continuing Education, 50 South Main St. Room 130, West Hartford, CT 06107-2447 (Tel. 860.561.6900, Fax 860.561.6907)

WOLCOTT CT, mail to Wolcott Adult Education, Wolcott High School, 457 Bound Line Rd., Wolcott, CT 06716 (Tel. 203.879.8423)

THANK YOU FOR JOINING OUR CLASSES or as Elvis would say, "Thang-ya,Thang-yaverymuch !"

RETURN to "Dance Classes in CONNECTICUT" or "MAIN PAGE"

MAIL-IN or FAX REGISTRATION FORM for Jim's Classes
I, the undersigned, by applying to participate in the following class in the Sponsoring Organization's program, do hereby waive, release, absolve, indemnify, and agree to hold harmless the Sponsoring Organization's organizers, employees, and supervisors and Jim Zaccaria.

Agree by signing here:__________________________ Jim's Dance Class titled:____________________________

MY NAME:_________________________CLASS DATES & TIMES___________________

MAIL ADDRESS:___________________________________________________________

CITY_____________________________________STATE_______ZIP_________________

HOME TEL# (___)(___)(____) WORK TEL# (___)(___)(____) E-Mail____________________

MAIL-IN or FAX REGISTRATION FORM for Jim's Classes
I, the undersigned, by applying to participate in the following class in the Sponsoring Organization's program, do hereby waive, release, absolve, indemnify, and agree to hold harmless the Sponsoring Organization's organizers, employees, and supervisors and Jim Zaccaria.

Agree by signing here:__________________________ Jim's Dance Class titled:____________________________

MY NAME:_________________________CLASS DATES & TIMES___________________

MAIL ADDRESS:___________________________________________________________

CITY_____________________________________STATE_______ZIP_________________

HOME TEL# (___)(___)(____) WORK TEL# (___)(___)(____) E-Mail____________________