Request to Join Zumba Illinois

Full Name: 

Street Address:          City:         

State:          Zip: 

Phone:  ()         Email: 

If you have a web site, please list the address: 

Are you a member of ZIN?  Yes     No

Am currently teaching classes:  Yes  No

     If 'Yes', please maintain your list of classes on zumba.com - we will link to
to that page to display your current schedule.

Are you interested in being a Sub for other instructors?:  Yes  No

Clicking 'Submit' will send your request to the Zumba Education Specialists
of Zumba-Illinois for approval - clicking 'Reset' will clear the form.