Director’s Home

National League of Junior Cotillions
Greater Hattiesburg Chapter

Registration

REGISTRATION NOW OPEN

2024-2025 Season Greater Hattiesburg Chapter

Fall Kickoff

We are so pleased you have decided to enroll your son or daughter in National League of Junior Cotillions, Greater Hattiesburg Chapter for this Season. Registrations may be completed online.

When you are registering, please be sure and select the Greater Hattiesburg Chapter on the class that you are registering for on the drop down menu on this line item.

Please contact the Director if there are any changes in address or contact information after registering.

The Class Schedule (TBA for the upcoming Fall Season) will be posted in the class tab and go then to the Classes Available section, click on the class you would like and it is listed under the class you selected.

YOU CAN ALSO LIKE US ON FACEBOOK

WWW.FACEBOOK.COM/NLJCHPBC

TUITION

Membership dues for Year I are: $340. Dues for Year II are $360 and include all costs for the training and ball pluse the instructional dinner. Dues for Premiere are $360. We highly recommend that you send in your reservation early, as class sizes are limited and are filled on a first come first-come first-serve basis. Payments can be made online using PayPal at www.nljc.com/chapter/hattiesburg and they do charge a fee for this, or checks made to Greater Hattiesburg Chapter. Please put your child's first and last name in the memo line and mail to our address below. Tuition may be paid in full with the application or half with the application and the remaining half by September 1, 2024. There will be no refunds except in the case of extraordinary circumstances such as moving or illness, in fairness to students who are placed on the waiting list. Payment plans customized to fit your budget are available. There is a discount for multiple children enrolled. Please contact the Director for the details.

Mailing address:

NLJC Greater Hattiesburg Chapter

Roma R. Graham

Director

122 West Canebrake Blvd.

Hattiesburg, MS 39402

REMEMBER THAT WE MEET ONCE A MONTH TO WORK WITH YOUR BUSY SCHEDULES.

2024-2025 Student Information

Class Registering For*

First Name*

Last Name*

Preferred Name*

Gender * Male Female

Salutation

Street Address *

City *

State *

Zip *

What school will the student attend in the fall *

What elementary school did the student attend*

Current Grade *

Grade Entering In Fall *

Birth Date (format: 5/13/2011)

Add additional child to this registration »

About the Parents

How did you hear about us?

Parent / Guardian 1 Salutation

Parent / Guardian 1 First Name *

Parent / Guardian 1 Last Name *

Parent / Guardian 1 Email Address *

Parent / Guardian 1 Email Address (Again)*

Parent / Guardian 1 Cell (or Preferred) Phone *

Parent / Guardian 1 Occupation

Parent / Guardian 2 Salutation

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Parent / Guardian 2 Email Address

Parent / Guardian 2 Cell (or Preferred) Phone

Parent / Guardian 2 Occupation

Photo and Video Release*

Please use the checkbox below to grant permission to the National League of Junior Cotillions and National League of Junior Cotillions Greater Hattiesburg Chapter to use photos and/or videos taken at NLJC events for any legal use, including but not limited to newsletters, publicity, and web content, UNLESS I notify the director, Roma Graham, in writing (with instructions and a photo of the child) before classes begin. The National League of Junior Cotillions will not use names or identifying information about students in any publication.

As the parent/guardian, I GIVE permission for images of my child(ren) to be used by The National League of Junior Cotillions in print or electronic materials as indicated above.

As the parent/guardian, I DENY permission for images of my child(ren) to be used by The National League of Junior Cotillions in print or electronic materials as indicated above.

Allergies * I understand the director will not be held responsible with respect to accommodating food-born allergies.

Note to Director

Payments I'll pay with PayPal* I'll pay by check

*an online handling fee of 4% will be added to PayPal payments.

Younger Siblings

We attempt to ensure that younger siblings receive an invitation to participate, once they have reached the appropriate age for cotillion classes. If interested, please provide some information about younger siblings.

Sibling 1 First Name

Sibling 1 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 2 First Name

Sibling 2 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 3 First Name

Sibling 3 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Sibling 4 First Name

Sibling 4 Last Name

Birth Date

Year entering fifth grade *

Elementary school child will attend

Please note: If your child has any special dietary restrictions or any conditions that would restrict their ability to participate in cotillion activities, please contact the director with those details.

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Director’s Home

National League of Junior Cotillions
Greater Hattiesburg Chapter

Registration

REGISTRATION NOW OPEN

Fall Kickoff

The Class Schedule (TBA for the upcoming Fall Season) will be posted in the class tab and go then to the Classes Available section, click on the class you would like and it is listed under the class you selected.

YOU CAN ALSO LIKE US ON FACEBOOK

WWW.FACEBOOK.COM/NLJCHPBC

REMEMBER THAT WE MEET ONCE A MONTH TO WORK WITH YOUR BUSY SCHEDULES.

2024-2025 Student Information

2024-2025 Student #2 Information

2024-2025 Student #3 Information

2024-2025 Student #4 Information

2024-2025 Student #5 Information

2024-2025 Student #6 Information

About the Parents

Younger Siblings