Club Name
City Where You Dance
Where do you dance
Address of dance hall
Type of dancing - check all that apply
Square - Mainstream
Square - Plus
Square - Advanced
Round
Clogging
Contra
Workshop
Other
When do you dance
Contact Name
Contact's Email
Contact's Phone #
Is this phone #
Home
Cell
Work
Contact's Mailing Address
Club Website, if any
Club facebook page, if any
Club caller, if any
Other things you'd like included
Other Comments