Application For Membership

Name:

Address:

Phone No:

Mobile No:

Email:

Date of Birth:
(applicant must be 18 yrs and over)

Application for Full Membership:

Qualified Teacher Only:

Qualified Teacher/Adjudicator:

Application for Associate Membership:

Qualifications:

Date Qualified:

Organisation Qualified with:
(Please supply a copy of qualifications)

History - Dance:

History - Teaching:

Please state area where you are teaching:

Enter the number: *