Enrollment Form

Step 1

Fill out and submit the form below.

Step 2

Send your non-refundable $100 deposit to Diane Jarmolow’s BDTC (instructions on Online Enrollment Page).

Online Enrollment Form

Salesfree Sales Training

Bronze Teacher Training:

Private Lessons

Certification Intensives

Move Like a Champion

Contact Information

First Name (required):

Last Name (required):

Address:

Address 2:

City:

State:

Zip/Postal Code:

Phone (Home):

Phone (Work):

Email (required):

Referral Survey

How did you hear about us?

If Other, please specify

Dance Background Details

Please tell me about your dance background, if any.


What is your main purpose in taking this course?


Are you interested in pursuing a career as a ballroom dance teacher? If so, why?

Please provide any additional information you think I should know about you.

Please send a non-refundable $100 deposit.

You will receive a call or email to confirm receipt of your enrollment form and deposit.

Payment in full is due NO LATER THAN THE FIRST DAY OF CLASS.

Please check one of the following


Diane Jarmolow's BDTC
6008 Ridgemont Drive
Oakland, CA 94619

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