Premier All-Stars – New Member Enrollment

Student Name*
First Last
Age*
Please enter a number from 4 to 18.
Date of Birth*
MM slash DD slash YYYY
Parent Name*
First Last
Phone*
Email*
Please Check
- I am on the Premier Dance Team
- I am NOT on the Premier Dance Team
Max number of group dances in which you would like to compete
I am interested in going to Nationals.
Nationals will be in January in Texas.
- Yes
- No
Product Name
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Street Address Address Line 2 City State ZIP Code

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