Subscription Application Form


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Secure Subscription Form

We respect your privacy. The personal information requested below is for use in processing your credit card, which is done with secure encryption. We never reveal, share, or sell member information. For complete details see our Privacy Statement.

Subscription Options

Subscription Plan:

1 Month Membership, Charter Membership ($37) automatic renewal - Instant Access & 4 Free DVDs! Your credit card will be charged automatically every month. Cancel anytime. All for Less than 1/2 the price of one (yes, 1) single private lesson, giving you the benefits of 1000's! Yes, you get 4 FREE DVDs as soon as you sign up, plus every subsequent BootCamp DVD (released every 3 months) mailed directly to your door.

3 Month Membership to SalsaBootCamp, Charter Membership ($67) automatic renewal - Instant Access & 4 Free DVDs! Your credit card will be charged automatically, once, every 3 months. Cancel anytime. Yes, you get 4 FREE DVDs as soon as you sign up, plus every subsequent BootCamp DVD (released every 3 months) mailed directly to your door. Great Deal, Save $$!

Yearly Plan Best Deal!, Charter Membership ($197) automatic renewal - Instant Access & 4 Free DVDs! Your credit card will be charged automatically, every year. Cancel anytime. Yes, you get 4 FREE DVDs as soon as you sign up, plus every subsequent BootCamp DVD (released every 3 months) mailed directly to your door.

Customer Information

* = Required - Must match credit card billing address!

First Name [ required ]
Last Name [ required ]
Company
Address Line 1[ required ]
Address Line 2
City [ required ]
State [ US & Canada ]
State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Country [ required ]
Your E-mail Address [ required ]
Phone or Fax Number [ required ]

Shipping Information

Shipping same as billing address

Ship To First Name [ required ]
Ship To Last Name [ required ]
Ship to Company
Ship to Address Line 1[ required ]
Ship to Address Line 2
Ship to City [ required ]
Ship to State [ US & Canada ]
Ship to State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Ship to Country [ required ]


Choose LOGIN Name [ required ]

Choose PASSWORD [ required ]at least six characters long, using alphas and numbers, no spaces.

Confirm PASSWORD [ required ]

Payment Information

Payment Method [ required ]
Credit Card Number [ required ]
Credit Card Security Code [ required on (MC/Visa/AMEX) ? ]
Expiration Date [ required ]	/
Name on Credit Card [ required ]
Is this a Renewal?
Do you wish to receive email alerts?
<<< Please Check The Box to acknowledge that you have read and understood our terms of use.


NOTE: It can take up to a minute to process the credit card information and obtain approval. Please do not press the submit button multiple times - doing so could cause double billing.
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