First name: ________________________ Last name: ____________________________

Date of birth: ___________ Address: ________________________________

City: ___________________________ State: ___________ Zip: ____________

Telephone: ____________________ E-mail: ____________________________

Work experience

Name of
company: _________________________ Years worked: __________________

Job Title: ________________________________________________________

Reference, phone # or email: ________________________________________

Name of
company: _________________________ Years worked: __________________

Job Title: ________________________________________________________

Reference, phone # or email: ________________________________________

Deposit:
Please make a check or money order of $500.00 to Toddlers’ Tango.
The remaining payment can be made at time of training.

If you have any questions contact
Tamar at toddlerstango@aol.com
I LOOK FORWARD
TO MEETING YOU.
CREATE A GREAT DAY.
Tamar Frieden
President.