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 *

My Products

Premium Membership $ 200.00

Tuition runs automatically every month on the day of enrollment (if you sign up on the 7th then it will be on the 7th of every month). We do not use contracts so you can cancel at anytime.

Free Class T-Shirt Size

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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.
Should be Empty: