Dance Class

February 18, 2025

Name *

First

Last

Firm *

Email *

Are you currently a member of QCWBA? *

• Yes
• No

Member Tickets

Number of member tickets1 – $25.002 – $50.003 – $75.004 – $100.005 – $125.006 – $150.00

Non-Member Tickets

Number of non-member tickets1 – $40.002 – $80.003 – $120.004 – $160.005 – $200.006 – $240.00

Enter the names of attendee(s) below:

Attendee 1 *

Attendee 2 *

Attendee 3 *

Attendee 4 *

Attendee 5 *

Attendee 6 *

Total Payment *

$0.00

Payment

Stripe Credit Card *

Card

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