Pink Jukebox Trophy Association - 2018 Membership Application Form
Use this form to apply for membership in the Pink Jukebox Trophy Association in connection with the 2018 Pink Jukebox Trophy.

Members must agree to abide by the rules of the Association, which are to dance with a partner of the same sex at the competition and to abide by the rules of the competition, which are the UKSSDC competition rules.

Payment is to be made separately using the PayPal form. Non-UK competitors ONLY may pay in cash at the competition.

Competitors' tickets allow entry to the entire day and evening of the competition, from 10 a.m. until midnight.

Name of Partner 1 *
Please use CAPITAL LETTERS for the competitor's surname
Your answer
Name of Partner 2 *
Please use CAPITAL LETTERS for the competitor's surname
Your answer
Contact e-mail address
Please be sure to provide at least one contact e-mail address or phone number.
Your answer
Second contact e-mail address (optional)
Your answer
Contact telephone number (home)
Your answer
Contact telephone number (mobile)
Your answer
Address (Number and street)
Your answer
City
Your answer
Postcode
Your answer
Country
Your answer
Please tick here if you do not want your name to be published on our website or in the programme
We would like to enter the dance competition in the following categories *
Required
In BALLROOM, we expect to compete at the following level
If you are entering in a Ballroom category, please select a level. Please note that the starter level is for those who have not previously competed in a dance competition other than the UK Fun Competition.
In LATIN, we expect to compete at the following level
If you are entering in a Latin category, please select a level. Please note that the starter level is for those who have not previously competed in a dance competition other than the UK Fun Competition.
Method of payment *
Please confirm your method of payment here. If you have not paid via PayPal, please confirm your means of payment in the Special Requests field below.
Special Requests
If you have any special needs (such as access or dietary requirements), or if you have not paid via PayPal, please provide information in the box below.
Your answer
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