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APPLICATION

Limited Spots Available. Application deadline Saturday April 15th, 2017

* Indicates required field

Name *

First

Last

Email *

Phone Number *

City *

Country *

Please include your digital addresses (Website, Facebook Page, etc.) *

In which category would you like to have a spotlight *

Performing Artist Dance Teacher Studio Owner All of the Above None of the Above Other

If you answered 'Other', please explain *

Bio *

Please select your role in Shimmy Mob (past or present) *

Team Leader Assistant Team Leader Dancer Rehearsal Assistant Supporter I have never participated

Year and Team location where you registered *

What else would you like us to know about you? *

Any additional comments *

Terms of Agreement *

I understand this application does not guaranteed a spotlight.

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