Premium Membership Enrollment

Premium Membership Enrollment

Two Members in One Course or One Member in Two/Three Courses = $200 Monthly
Student Name *

First Name Last Name
Birth Date

Month Day Year
Gender
Address *

Street Address

Street Address Line 2

City State

Zip Code
Student E-mail *
Mobile Number *

Area Code Phone Number
Your Course *
In consideration for my attendance and participation at Virginia Beach Kung Fu/Tai Chi and Chesapeake, Kung Fu/Tai Chi I, the student, acknowledge the existence of certain inherent risks in this type of training and hereby agree to assume all risks. I further relieve Virginia Beach Kung Fu/Tai Chi and Chesapeake Kung Fu/Tai Chi, and fellow students, from any liability resulting from personal injury or loss of personal belongings. I also state that I am physically fit to take the prescribed course of instruction and do so of my own free will. I will seek my doctor's approval if I have any physical concerns before participating in this type of training course *

I Agree to the Terms & Conditions above
Yours for Better Health, Greater Strength and Competent Skills.
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