Pole Dance Instructors Application, We are currently not accepting applications in Philadelphia PA, Southern NJ, or Delaware all other USA areas may apply

Full Name *
City *
State *
Phone # *
Have you taken any Pole Dance Classes before. *	Yes No
Where did you take your classes *
Have you ever taught a Pole Dance Class *	Yes No
Do you own an X-Pole or Platinum Stage Pole *	Yes No
Do you need to buy a portable Pole *	Yes No
What Cities in your area can you work in List all that apply. *
Are you available for work on weekends *	Yes No
Your E-mail Address *
Do you have a vehicle available to use on weekends *	Yes No