Registration Form

Registration Form

← Back

Thank you for your response. ✨

Name

Phone

Date of birth (YYYY-MM-DD)

Instagram handle

How long have you been practicing pole?

What level do you consider yourself?

Do you have any injuries or medical conditions?

Do you have any dietary restrictions?

What are you hoping to get out of this experience?

If you have a specific roommate request, please provide their name.

How did you hear about SpIN CITY POLEcation?

Upon arrival, you will be receiving a swag bag with goodies. The items vary for each POLEcation, but some items may require sizing details. If you wish to receive said goodies, please provide your sizing.

Please provide your polewear sizing.

Please provide your pole heels sizing.

Is there anything else you’d like to share?

Congratulations on choosing to invest in YOURSELF & be a part of this special experience. We’ll be in touch shortly. ❤