Central Iowa Dance Classes

Create a New Account

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Student General Information
Username	(max 25 characters)
Password	(Min 6 characters, max 15)
Confirm Password
First Name
Last Name
Gender	Male Female
Date of Birth
Address 1
Address 2
City
State
Zip Code
Email
Grade
Default Location
Parent/Guardian Information
First Name
Last Name
Date of Birth
Work Phone	xxx-xxx-xxxx
Home Phone	xxx-xxx-xxxx
Cell Phone	xxx-xxx-xxxx
Email
Captcha code verification
Enter the UPPERCASE letters as shown in the image

User Verification Via Credit Card
Card Number
Card Verification Number
Expiration Date
Card holder First Name
Card holder Last Name
Card Billing Address
Card Billing Address City
Card Billing Address State
Card Billing Address Zip
Card Holder Phone	xxx-xxx-xxxx
Card Holder Email
Note: Your credit card will NOT be charged. Only a temporary authorization request for 1 cent will be sent to your credit card which may show as a pending charge on your credit card online recent transactions and will be removed within 30 days and will NOT show up on your credit card statement.

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