daCi USA Children's Dance Group Membership

Children's Dance Group Name: * E-mail Address: * Contact Name: * Title/Occupation/Description: (15 words or less) for the Directory Children's Dance Group membership includes membership privilages for 1 additional adult group member: Name: Email: Membership Type: * Children's Dance Group - $75 Street Address: * City: * State: * --Select-- Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Washington, DC Wisconsin West Virginia Wyoming --Territories-- American Samoa Federated States of Micronesia Guam, DC Midway Islands Puerto Rico U.S. Virgin Islands Zip Code: * Phone Number: * Home Work Cell Phone Number (2) Home Work Cell Number of Children in your group If you have a website, and would like the site listed on the LINKS page of the daCi USA website, please indicate your web address: Dues Acknowledgement: * Mailed Hard Copy Attachment to e-mail   Copy the text: * Not case-sensitive * Required ^