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Membership Type *	DivaGirl Member ($15.00 for each month) Ideal for women who want to get fit, have fun and feel sexy! Includes: Access to the Library of videos and choreography notes, Discussion Forum and special offers from DivaGirl Fitness! DivaGirl Licensee ($35.00 for each month) For DivaGirl certified instructors only. All the above plus the ability to profile yourself and be listed in the Instructor directory, ability to upload your classes and workshops, with online registration capability (linked to your Paypal account captured on the registration form to this membership) and access to Business Training Resources. The Username you select below will be visible to the public. We recommend using your first and last name as one word.
Payment System *	PayPal secure credit card payment
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'
Choose a Password * Must be 4 or more characters
Confirm your password * Enter password again
Website All the following fields are optional and mostly apply to DivaGirl Licensees only. Feel free to skip to the bottom if you are signing up for a basic DivaGirl membership.
Training Experience How many years have you been teaching in dance/fitness?
DivaGirl Certifications Which DivaGirl Instructional Workshop have you been certified in? Please check all that apply.	Dance Grooves Dance Grooves II Sexy Fitness Sexy Dance Sweat Ihave not yet attended an instructional workshop. Please send me information regarding one coming up in my area.
Certification Info When and in which city did you complete the course?
Top 5 styles you teach Please list your top five styles of dance/fitness that you teach. If available, please include a description.
What cities do you teach in? Please list all the cities in which you plan on teaching classes/servicing.
Teaching Status Do you currently teach and run your own classes/workshops/events (i.e. through your own business. This does not include being employed by a gym or another facility)?	Yes No
If yes, please answer... How long how you been teaching your own classes/workshops?	10+ years 5-10 years 3-5 years 1-2 years 0 years- I am just starting
Class Locations How many locations do you currently run classes/workshops?	I don�t currently run my own classes 1 location 2 locations 3-4 locations 5+ locations
Special Events? Do you host any special workshops/events?	Yes No
If yes, please check... Please check all that apply.	Girl�s Night Out Parties Monthly Featured Workshops Bachelorettes Birthday Parties Instructional Workshops Dance/Fitness Conferences or Seminars
Others Please list
DivaGirl Preferences Why would you like to join the DivaGirl Community? Please check all that apply.	Promotion of my classes/events via the website To reach a greater target market of ladies Promotion of my classes/events via the monthly newsletter Online registration of classes Network opportunities with other instructors Marketing/business advices/tips to run my own business Dance/Choreography tips and advice Music knowledge/tips Attendance at the annual DivaGirl Conference, to be held at the end of the year To expand my knowledge in dance To expand my knowledge in fitness
Top 3 Reasons From the list above, please number your top three reasons why you would like to be part of DivaGirl. Please label your preference with #1, #2, #3, with #1 being the most important.
Instructor Database Would you be interested in being in the instructor database for teaching parties/events in your area?	Yes No
Workshop Database Would you be interested in being in the instructor database for teaching workshops at corporate/fitness/dance facilities in your area?	Yes No
Refer a friend Please list two ladies that you think may be interested in the DivaGirl Licensee Program.* If we have permission to contact them about this opportunity, please submit their names and emails. If you refer a friend to DivaGirl, who signs up for the licensee program, you receive a FREE month of membership* (max. of 1 FREE month only). For every additional friend you refer, who signs up for the DivaGirl licensee program, you receive a 10% discount for one month (up to 3 months only).
How did you hear? How did you hear about the DivaGirl Licensee Program?	Laura Furtado DivaGirl Fitness Website Internet A current DivaGirl Licensee. Please name who referred you (please specify in box below). A friend/collegue CanFitPro conference Fitness/Gym Facility (please specify in box below) Facebook Group Partner website (please specify in box below) Other
Please specify from above If necessary, specify more details about how you heard about us.
Did you enter your Paypal Email? * If you are signing up as a Licensee, did you make sure to use your Paypal email address as your email address at the top of this signup form? (If not, please change it now)	Yes No