Workshop Registration
Complete form below to signup for the workshop.
Name
First Name
Last Name
E-mail
example@example.com
Company
Title
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Payment reference
How many will attend?
prev
next
( X )
Workshop Registration: Early Bird price
$
530.00
Quantity
1
2
3
4
5
6
7
8
9
10
Holding Deposit
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Screenshot of payment
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How did you hear about the workshop?
Web Site
Friend/Colleague
Online Search
Any medical conditions
Prior kungfu/ sports training
Yes
No
Unsure
What do you hope to achieve from attending and learning in the workshop?
Payment to Complete Registration
Should be Empty: