Salsa Level 1 Sign-up

Salsa Level 1 Class Registration

Payment Form
Student Name

First Name Last Name
Email
[email protected]
Phone Number
Please enter a valid phone number.

Class Price *

Salsa Level 1

$ 80.00 for each month

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty:

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