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First Name:
Last Name:
Company:
Email:
Phone:
Address 1:
Address 2:
City:
State:
Zip:
Comments:
You can pay your deposit here now to save your special date! Please fill out the contact form below and you will be contacted within 48hrs!
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Name of Hostess
Occasion being Celebrated
Address of Party
city and zip
Home Phone
Cell Phone
Email
Confirm Email
Party Length Chosen
1 1/2 Hours
2 Hours
2 1/2 Hours
3 Hours
Date Requested
Time Requested
Hours
01
02
03
04
05
06
07
08
09
10
11
12
:
Minutes
00
15
30
45
AM
PM
A $50 Deposit is required to reserve your Pole Party.
Yes, I am ready to book my party! I'm so excited!
I need more information. Please contact me.
I prefer to be contacted by:
Home Phone
Cell Phone
Email
I would like more information about:
Private Pole Dancing Lessons
Monthly Parties to learn more with Friends!
Hosting a relaxing Spa Party with Friends!
Hosting a combo Pole/Spa Party!
Having a Wine Tasting Party or Combo Party
Havinga Naughty Girl Party, too!
Where did you hear about us?
Craig's List
Website Search
A friend
Picked up your business card
Went to a Naughty Girl Party
Website
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