Ballroom Registration Step 1 of 2 50% HiddenNext Steps: Install a Payment Add-OnTo accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.Contact DetailsName(Required) First Last Email(Required) Enter Email Confirm Email PhoneDo you have a partner for this session?Please choose option belowYes!Not yet. But I'm working on it.I would like to be paired with with someone, if possible.I'd prefer to learn as a single.Partner's Name First Last Event DetailsWhich class are you registering for?(Required) Beginner Ballroom (5 weeks) Intermediate Ballroom (5 weeks) Private Lessons When are you available for private lessons? An instructor will reach out to you via email or phone to schedule your first lesson.What date does your session start? Do you have a special event coming up that you are preparing for? How did you hear about this class?Choose option belowSocial MediaGoogleWord of MouthRefer a FriendPast ParticipantOtherPayment DetailsHow would you like to make a payment?Select Payment OptionChecking Account ($2.00 Conv. Charge)I'll pay via VENMO: @AmandasAcademyI have an AAD account. Please use the banking information on file.EFT Conv. Charge Price: Total Bank Account Payment - EFT Routing Number (9 Digits) Account Number Name of Banking Institution I hereby authorize you to debit my account as identified above. This authorization shall remain in effect until the terms stated have been met or until Amanda’s Academy of Dance has received written notification from me of intent to terminate at such time and in such manner as to afford Amanda’s Academy of Dance and bank reasonable opportunity to act (minimum of 30 days). All other changes such as payment amount, frequency, bank account number change, will require a new Payment Authorization Form to be filled out and submitted to Amanda’s Academy of Dance 5 days prior to any change being implemented. I understand that this payment plan may be cancelled by Amanda’s Academy of Dance due to uncollectible funds. I will be liable to pay a fee for each returned check. I understand that if my electronic debit is returned to you for insufficient or “held” funds, it will be re-presented electronically and my account will be debited for the amount of the payment plus the state-allowed fee. I represent and warrant that I am authorized to execute this payment authorization for the purpose of implementing this payment plan. I indemnify and hold Amanda’s Academy of Dance the check processor, and the bank harmless from damage, loss, or claim resulting from all authorized actions hereunder.