Student Regional Workshop Application

To attend a Student Regional Workshop, complete the form below and pay via PayPal. Paper registration forms will no longer be accepted.

Workshop Host Studio*
Workshop Date mm/dd/yyyy*
MM slash DD slash YYYY
Name*
First Last
Age*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Ballet Scholar (if under 18 years of age) or Teacher Member Number

Dancers/Teachers Need Not be Members to Attend
Parent Name (if under 18 years of age)
Most Recent Successfully Passed Exam

If Applicable
Dance Studio/Teacher Name
Number of Classes to be Taken*
- 1 Class
- 2 Classes
- 3 Classes
- Unlimited Classes
Must Produce Member Number in Order to Receive Discount
Please List Classes to be Taken*
Terms and Conditions*
- I Agree
CUSA shall have the right to use the names, photographs, videos or other likeness of the student listed above and to exhibit the same through any medium for advertising, promotional or commercial purpose. All such reproductions shall be the exclusive property of CUSA, without compensation to the performer, family members and/or agents. By indicating "I agree", I have read and understood this photo/video release and agree to the conditions thereof.