Please identify and describe yourself:

1. Name
   Date of Birth
   Sex	Male Female
   Height
   Weight
   ID Number
   Hair Color	Blonde Brown Black Red Gray White
   Eye Color	Blue Brown Black Green Gray Violet

2. What Level of Dance are you at:

3. Performer
   Competitor
   Instructor
   Advanced
   Intermediate
   Beginner
   Novice
   

Select any of the following options that apply:

Cha Cha
Salsa
Rumba
Samba
Hustle
Tango
Meringue
Swing
FoxTrot
Waltz

1. Do you attend Classes:

   Yes
   No

2. How often do you attend classes:

   3-5 times per month
   1-2 times per month
   Once every two month
   other

3. Are you looking for a partner to take classes with:

   Yes
   No

4. Please rate your overall experiences with Dance Classes:

   Terrible
   Not Quite what I expected
   Satisfied my needs
   Enjoyable
   Exceeded my expectations
   Fantastic

5. Are you interested in dancing on DanceVids:

   Yes
   No
   
   Are you interested in a video of you and your partner:

6. Yes
   No
   
   Please provide the following contact informationn:

7. First Name
   Last Name
   Title
   Organization
   Street Address
   Address (cont.)
   City
   State/Province
   Zip/Postal Code
   Country
   Work Phone
   Home Phone
   FAX
   E-mail
   WebSite Address