Portland Highland Dance Association

TEACHER MEMBERSHIP FORM 2015-2016 Portland Highland Dance Association membership form for Highland Dance teachers in Oregon and Clark County, WA. Membership fee is $25.00 per teacher for the competition season. Teachers must be a member of PHDA to be included on the PHDA website. Teacher information: Name_________________________________________________________________________ Street Address _________________________________________________________________ City _____________________________________________State __________Zip ____________ Email_________________________________________________ Phone: __________________ To be included on PHDA website: Please email studio logo or headshot of instructor to [email protected] Studio Name ____________________________________________________ Studio Location _____________________________________________________ Preferred contact info for prospective students (i.e. email, phone) ____________ Website or Facebook Page address ____________________________________ Accepting students at this time?  Yes  No Credentials and Membership. Check any that apply:  UKA  BATD  SDTA  SOBHD Judge  FUSTA Visit the PHDA Facebook page and webpage for updates. www.portlandhighlanddance.com PHDA is a 501 c 3 organization

Portland Highland Dance Association

TEACHER MEMBERSHIP FORM 2015-2016

P l e a s e m a il f o r m a n d c h e c k to : Ra ma n a S c ul lio n P H D A Co m pe t it io n S e cr e t a ry 1 6 2 0 9 N W S p ygla s s D r. Be a ve rt o n , O R 9 7 0 0 6

E m a i l o r p h o n e q u e s ti o n s to : ra ma na w @ ya h o o .c o m (5 0 3 ) 8 8 7 - 0 3 3 5

I am available to volunteer at the following competitions: Fall:

Winter:

Spring:

I am interested in volunteering in these areas. (Time commitment 1 -2 hours.) -in

Visit the PHDA Facebook page and webpage for updates. www.portlandhighlanddance.com PHDA is a 501 c 3 organization