Use this form to register for the Xplosion Girls Dance Team audtions on Saturday, October 27, 2007,
or call 724-787-5179 to register over the phone or more information!
 

Please provide the following contact information:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail
Age

List ALL Experience (Dance, Choreography, Cheer, Gymnastics)

List ALL Modeling and Talent Experience (TV, Print, etc.)

What can you bring to the Xplosion Girls Dance Team?

What is your most appealing attribute?

If someone were to describe you in three words, what would they be?

Registration Fee is $30.00.

CHECK AND MONEY ORDERS:
Please make checks and money orders payable to: PRO BASKETBALL INC.
and return to: Pittsburgh Xplosion c/o Brittany O'Connell
200 James Place Suite 302, Monroeville PA, 15146

CREDIT CARD ORDERS:
Please provide the following billing information for credit card payments:

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Type of Card
Credit Card Number
Expiration Date
Three-Digit Security Code