Shushi Armenian Dance Ensemble Membership 2017-2018
Last Name *
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First Name of Member 1 *
Your answer
Date of Birth of Member 1 *
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Email of Member 1
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Mobile Number of Member 1
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Any prior dance experience? *
If yes, please explain
Your answer
First Name of Member 2
Your answer
Date of Birth of Member 2
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DD
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YYYY
Email of Member 2
Your answer
Mobile Number of Member 2
Your answer
Any prior dance experience?
If yes, please explain
Your answer
First Name of Member 3
Your answer
Date of Birth of Member 3
MM
/
DD
/
YYYY
Email of Member 3
Your answer
Mobile Number of Member 3
Your answer
Any prior dance experience?
If yes, please explain
Your answer
First Name of Member 4
Your answer
Date of Birth of Member 4
MM
/
DD
/
YYYY
Email of Member 4
Your answer
Mobile Number of Member 4
Your answer
Any prior dance experience?
If yes, please explain
Your answer
Mother's Name *
Your answer
Mother's Email *
Your answer
Mother's Mobile Number *
Your answer
Father's Name *
Your answer
Father's Email
Your answer
Father's Mobile Number
Your answer
Home Street Address *
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City *
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State *
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Zip Code *
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Home Telephone
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Work Telephone
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Will you be willing to help or get involved in any Shushi activity? *
If yes, in which Area?
How did you hear about Shushi Dance Ensemble? *
Your answer
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