June 25-28, 2008 Wichita, Kansas

                               Clogging Program – Clogging Instructor Profile

                                    Deadline for returns – March 1, 2008

Name(s):           

Spouse's Name:

Street:               

City:        State:     Zip+4:

Country:  Province:

Home Phone:   Email:

Work Phone:

I will participate in the following Areas (Please check all that apply):

                Teaching:   Cueing:   M.C.

I have been teaching Clogging for     Years.

I will be available on:      Thursday         Friday         Saturday

I will be wiling to fill in if asked:  Yes No

I have taken part in     National Square Dance Convention Programs.

I have taught at Clogging Workshops   Yes No

I can teach these levels: Beginner   Intermediate   Intermediate+    Advanced

I can also teach:  

Buck   Canadian Steps   Circle Dances   Couples Dances  

Mountain Figures   Country Western Lines   

Additional Information:

══════════════════════════════════════════════════════════════

Exhibition Request (you will be contacted):

Team Name:  

Contact Name:

Number of Participants:     Phone Number:

Email:

Contact or Mail:    Joseph (Joe) Dawley

                                Vice-Chairman, Cloggin

                                2001 East Blake

                                Wichita, Kansas 67211-5338

                                joed363@cox.net