Instructional Video Order Form Please Print this Form and Fill it Out Please make your check or money order payable to Boca Ballroom, and mail it with this order form to: Boca Ballroom 6359 N.E. Federal Highway Boca Raton, FL 33487 (561) 279-9896 First & Last Name: _________________________________________________ Street Address: ________________________________________Apt.#:______ City: _______________________________State:___________Zip:__________ Country:_________________________E-mail Address:__________________ Telephone: (_____) _______________________Fax: (_____) ______________

ayable to Boca Ballroom, and mail

Video Description VHS or DVD Price Quantity Total Associate Bronze Level: Foxtrot / Waltz  10 Steps, Man's and Lady's Parts   $25.00     Triple Swing / Rumba / Cha Cha  15 Steps, Man's and Lady's Parts   $35.00     Tango / Mambo-Salsa / Merengue  15 Steps, Man's and Lady's Parts   $35.00     Samba / 4-Count Hustle  10 Steps, Man's and Lady's Parts   $25.00     Latin Motion and Styling  Man's and Lady's Parts   $35.00     Full Bronze + Level: Argentine Tango 11 Steps, Man's and Lady's Parts   $25.00     Salsa II 11 Steps, Man's and Lady's Parts   $30.00     Merengue II 11 Steps, Man's and Lady's Parts   $25.00     Single Swing 10 Steps, Man's and Lady's Parts   $25.00     Foxtrot / Waltz II 10 Steps, Man's and Lady's Parts   $25.00     Triple Swing / Rumba / Cha Cha II  15 Steps, Man's and Lady's Parts   $35.00     3-Count Hustle I and II 10 Steps, Man's and Lady's Parts   $25.00     Full Bronze + Silver Level: Full Bronze Bolero 10 Steps, Man's and Lady's Parts   $25.00     Full Silver Bolero 10 Steps, Man's and Lady's Parts   $25.00           Subtotal         Add $4.50 S&H per Tape or DVD         Total