I would like to register to be assigned to a Mentor in the Field of:

Field of Dance: Ballet/Pointe Tap Jazz Modern Gymnastics

Dance Therapy Sports Medicine Drill Team/Cheerleading Costume Design

Stage Design Journalist/Historian Art Choreography Labanotation Production

Other (please specify)

I am currently a: Student Coach Performer Apprentice

Other (please specify)

Schools and/or professional affiliations

Letters of reference may be obtained from

Your name

Your age

Your phone

Your address

Your City/State

Your zip code

Your email

Your web site

MENTEE APPLICATION

I would like to register to be assigned to a Mentor in the Field of:

Ballet/Pointe ______ Tap ______ Jazz _______ Modern _________

Gymnastics ______ Dance Therapy ______ Sports Medicine ______

Drill Team/Cheerleading ________ Costume Design _______

Stage Design _______ Journalist/Historian _______ Art _______

Choreography ______ Labanotation ______ Production ______

Other (please specify) ____________________________________

I am currently a: Student _______ Performer __________ Apprentice ______

Other (please specify) ________________________________

Schools and/or professional associations:_________________________________

______________________________________________________

Name_________________________________________________ Age ______________

Address____________________________________ Phone __________________

City________________________State_____Zip Code_________________________

Email address___________________ Website ____________________

________________________________________________

Signature: ______________________________________________

Either Fill out the online form above & press Submit or
Print this form out, complete, and mail to:
Patricia Goulding
NDW Executive Director
142 Parkedge Rd
Pittsburgh, PA 15220