Registration Form
Please fill in each question completely. Thank you.
Email address *
Class Selection *
First Name *
Last Name *
Gender *
Phone *
Residential ZIP code *
Approximate Age *
List any special accommodations or assistance you may need in order to participate in this class. *
Please list any and all previous self defense, martial art &/or fighting experience you have. Please include time in training, rank and time since you've last trained regularly. *
Write a brief statement on why you want to attend this seminar and what you would like to see as an outcome. *
Are you able to attend every session listed in the course description? *
Preferred payment method (due at or before beginning of first session). Checks are not accepted. *
Have you already signed our waiver? *
Emergency Contact Name *
Emergency Contact Phone *
How did you find out about us or this class? *
A copy of your responses will be emailed to the address you provided.
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