LMA Night Class

LMA Night Class

Registration
Date

MonthDayYear
Date
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Age: blanks M/F blank
Email
example@example.com
Place of Work or Business:
If under the age of 18 years of age:
Primary Parent/ Guardian:   First Name   Last Name
Place of Work or Business:
Work Address:   Street Address   Address Line 2   City   State   Zip
Area Code   Phone Number
Other Contact's   Area Code   Phone Number
Email
Second Parent/Guardian: First Name   Last Name
Place of Work of Business blank
Work Address:   Street Address   Address Line 2   City   State   Zip
Area Code   Phone Number
Other Contact's   Area Code   Phone Number
Email
Why are you seeking martial arts training?
How did you hear about us?

Walk InAdvertisingReferral
Who can we Thank for referring you?
Class Tuition Fee's

Agreement Options

(Uniform $55 ea.)

Per. Student

12 mo. $75 mo. 6 mo. $95 mo. Mo. to Mo. $105 mo.

2nd - $150 ($10 off) =$140 $190 ($10 off)=$180 $210 ($10 off)=$200

3rd - $225 ($20 off) =$210 $285 ($20 off)=$265 $315 ($20 off)=$295

4th - $300 ($30 off) =$270 $380 ($30 off)=$350 $420 ($30 off)=$390

All New Students Receive 1/2 off 1st Month Tution

12 mo. $37.50 + $55 (Dobok)=$92.50 ea.

6 mo. $47.50 + $55 (Dobok)=$102.50 ea.

Mo. to Mo. $52.50 = $55 (Dobok)=$107.50 ea.

2nd Month Regular Tuition Applies on All Agreements.
Please Make your Choice per student.

12 mo. $756 mo. $95Mo. to Mo. $105
Please Make your Choice for 2 students

12 mo. $140 2nd Student6 mo. $180 2nd StudentMo. to Mo. $200 2nd Student
Please Make your Choice for 3 students

12 mo. $205 3rd Student6 mo. $265 3rd StudentMo. to Mo. $295 3rd Student
Please Make your Choice for 4 students

12 mo. $270 4th Student6 mo. $350 4th StudentMo. to Mo. $390 4th Student
Signature

Clear
Should be Empty: