Please print this form and submit it to Christy Lane Enterprises at:

Fax to: 1-800-555-0206
Mail to: Christy Lane Enterprises, PO Box 4040, Palm Springs, CA 92263-4040

Today's Date: ___________________________ 

Contact Person: _____________________________________________

Organization: _______________________________________________

Mailing Address: ____________________________________________

City: __________________________ State: ___________ Zip: _______

Check here if home address: ______ Check here if organization address: ______

Home Phone Number:________________________________________

School or Work Phone Number: ________________________________

Fax Number: ________________________________

E-mail: ____________________________________

Age Range of Participants: _____________________________________

Requested Dates: ____________________________________________

Requested Times: ____________________________________________

Type of Event: _______________________________________________

Type of dance:  ______________________________________________

Comments: _________________________________________________