Dance Fitness Line Dancing (Pocahontas)
Please complete this form to begin your registration for the Dance Fitness Line Dancing Class on Tuesday nights from February 20 - March 26. 

Registration is not complete until payment of $55 is received in full.  Checks may be mailed to Black River Technical College, Community Education, P.O. Box 468, Pocahontas, AR 72455.  

Registration deadline is Friday, February 16.

Payments may also be submitted by phone at 870-248-4180.  

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Email *
First Name *
Middle Name *
Last Name *
Mailing Address  
(Example: 1234 Test Way)
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Mailing Address 
(Example: Pocahontas, AR 72455)
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Date of Birth *
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Sex: *
Phone Number (Ex: (555-555-5555) *
Email Address *
How did you hear about this class? *
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