Exotic Divas Registration Form
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* All fields are required.  You may also register over the phone 949-903-1867
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip Code
* Country
* Phone Number
* E-mail
How did you hear
about us?
BILLING ADDRESS
* Billing Address
* City
* State/Zip
CREDIT CARD INFORMATION
* Card Holder's Name
* Credit Card Number
* Expiration Date
 C V V
Intro Class     $35
Register for:
4 weeks 4 classes   $100
4 weeks 8 classes   $200
6 month membership 8 classes per month   $600
Lake Forest
Studio:
 Long Beach
Sacramento
San Diego
Lake Forest
Los Angeles
Las Vegas
Riverside
When would you like
to start?
Would you like to
receive our Newsletter?
 Yes
 No
_______________________________________________________________________________________
INFORMED CONSENT/WAIVER OF LIABILITY
From Mind To Body/Exotic Dance For You Course

I acknowledge that I have voluntarily chosen to participate in a
program of progressive physical movement, whether it be in the form
of dance or exercise.

I also accept full responsibility for my use of any and all apparatus
(including the dance pole and stage), facility or service whatsoever.
I will not hold the instructors, studio owner, or From Mind To Body
liable.

From Mind To Body and Studio owners both reserve the right to
revoke, terminate and suspend any registered person due to
persistent behavior of a disruptive or dangerous nature, including
but not limited to constant disrespectful interruption, verbal abuse or
any other forms of disruptive or dangerous behavior..

I Agree to these terms
Yes
 No
You will receive a confirmation e-mail after we receive your registration.
There is no refunds or transfers.  
Click here for our frequently asked questions.
You may also register over the phone please call us at 949-903-1867