Anmeldeformular für fortlaufende Kizomba Kurse

Course registration

Salutation

First name

Surname

Street, house number

Postcode

Town

Phone number

Date of birth (optional)

Specifying of the dance level

Rate

Course month

Course day

Payment

Couple registration or single registration

Distribution of roles in couple dance

Freitext

When registering as a couple, please provide the details of the dance partner in full.

Dance partner: First and Last name

Dance partner: Address

Dance partner: Phone Number

Dance partner: Email

Your message to us (optional):

How did you become aware of us? (optional)

Field name

I have read the General Terms and Conditions (GTC) and the Data protection declaration and I agree to them. I consent to the transmission and processing of my message.