2008 / 2009 New Student Registration

Student name: ________________________________________ D.O.B: ___________

Parent's Names: ________________________________________________________

Address: ____________________________________________Zip Code___________________

Phone #: (_____)_______________ E-mail: ____________________________________

Preferred location and class________________________________

Have you taken Irish Step in the Past?____________________

If so: With whom? ________________________________________

For how long? ________________________________________

What competition level? ________________________________________

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Please return with your $15.00 registration fee to:

Brenda Hamilton Coleman, T.C.R.G.

7 Pearl Street

Wakefield, MA 01880

make checks payable to MSOID