Please complete this form to receive the 2011 Entry Forms and additional information.
(Teachers only please).

Fields marked with an asterisk are required.

Title	Mr. Mrs. Ms.
First name *
Last name *
Studio *
Address
City
Province
Country
Postal Code
Phone Number (with area code)*
Email address *
Confirm Email address *
Verification graphic:	(Can't read the letters? Hit reload in your browser to get a fresh image. Note that any '0' that appear in the graphic are the number zero and not the letter 'O'.)
Type the characters appearing in the image above: *	(This step ensures that only real people use the form and that it is not abused by automated processes.)
Comments

Please contact us at info@jumpshoutboogie.ca with any questions.

Entries are due January 15, 2011, space permitting.

EARLY BIRD SPECIAL
A 10% discount from entire fees is available to all studios when spots are reserved on or before November 15, 2010. All forms and payment must be received by December 15, 2010 to qualify. It is recommended that reservations are made early as some locations may fill up quickly.

Mail entries to:

Jump Shout Boogie
218 Steeles Avenue East
Thornhill, ON
L3T 1A6
(416) 459-1997