2021 MDC New Interest Form

2021 MDC New Interest Form
Millennium Dance Co 2021 NEW Interest Form:

Dancer Details
Student Name *

First Name Last Name
Date of Birth

Month Day Year
Date
Age as at 1 September 2021
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Mobile Number *

Area Code Phone Number
E-mail
Have you ever participated in APDA (Australian Physie and Dance)

Yes No
Physie Code and the Last Year Competed in other Physie Code
Heading
"Other" Physie Code Level (State/National Competition/Placegetter
Are you interested in Individual Apda Competitions (Interclubs, Age Selection Competitions) and being considered for MDC Teams in 2021

Yes (Individual) Yes (MDC Teams) No
Please tick location to receive information packs. Info pack will contain enrolment information, timetables and fees.

Millennium South (Victoria Point) Millennium North (Chermside)
Should be Empty:

Millennium Dance Co 2021 NEW Interest Form: