Creative Dance Certification Registration - **Early Bird Registration** Session 2

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Thank you for your interest in attending the Online Dance to Learn® Creative Dance Certification Conference 1/6-2/17/2020.
To reserve your spot, please fill out the registration form completely. Please note, you will be agreeing to important and bindbing legal statements. Registrations without payment cannot be processed.

Thank You

First Name *

Last Name *

Organization *

Title

Email Address *

Contact Phone Number *

Address 1 *

Address 2

City *

State *

Zip *

What Best Describes You? *

Dance Teacher

ECE Teacher

Elementary Teacher

School Admin (Principal, Director Etc)

Occupational Therapist

Psychologist

Parent

Other Other

How did you Hear about the Dance to Learn® Creative Dance Certification? *

Social Media

Phone

Google Search

Other Other

Are you Interested in becoming a Sponsored Educator for Dance Exploration, LLC? (Available for Teachers in Colorado Only)

* 🛈

Yes

Are you Interested in hosting your Classes through Dance Exploration, LLC? (Available for Teachers in Colorado Only)

* 🛈

Yes

How do you intend to use the Dance to Learn® Creative Dance Certification? (Select all that apply) *

Teach Creative Dance at one site

Teach Creative Dance at multiple sites

Teach Creative Dance for Dance Exploration, LLC

Teach Creative Dance for an existing business

Start a Business Teaching Creative Dance

Other Other

Please list any sites (schools, dance studios, wellness centers, existing businesses etc) that you would like to teach the Dance to Learn® Creative Dance Curriculum. If you do not have an existing site, please type N/A *

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