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The Pink Jukebox Trophy 2025 Membership Application
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Preferred Method of Contact
Please be sure to provide contact details that correspond with your preferred method of contact. It is not necessary to provide other types of contact details.
Required
- Required.
Email
Text Message
Telephone Call
Post (Mail)
*
Names
Required
- Required.
Partner 1 Name:
Partner 2 Name:
Mailing Information
Street Address:
City:
Post Code:
Country:
Email Information
Contact Email 1:
Contact Email 2:
Telephone Information
Phone Number 1:
Phone Number 2:
Special Needs
*
Intended Competition Categories
Required
- Required.
We intend to compete in the Women's Latin competition
We intend to compete in the Men's Latin competition
We intend to compete in the Men's Ballroom competition
We intend to compete in the Women's Ballroom competition
We intend to compete in the Open Ballroom competition
We intend to compete in the Open Latin competition
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Anticipated classification (Starter, D, C, B or A) for each category:
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This is required
Country or countries represented
Please identify the country or countries that you are representing (for the programme and/or the website)
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Privacy consent
Required
- Required.
We both consent to the publication of our names and country on the website and in the programme
We both consent to the publication of our names and country on the website but not in the programme
We both consent to the publication of our names and country in the programme but not on the website
We do not consent to the publication of our details