Lumpini Combat - Registration Form!

What's your name?* This field is required.

First Name

Last Name

How do you prefer to be contacted?* This field is required.

SMS/Text

Phone

How did you hear about us?* This field is required.

Walk By

Google Maps

Word-of-Mouth

Instagram

What's your style?* This field is required.

Krav Maga/Self-Defence

Muay Thai

Traditional Boxing

B. F. Savate

Kickboxing

Calisthenics

Conditioning

Private Classes

Kids (5+) Classes

Email* This field is required.

example@example.com

Phone Number* This field is required.

Please enter a valid phone number.

Address* This field is required.

Street Address

City

State / Province

Postal / Zip Code

Country

What's Your Birthday?* This field is required.

Date

Signature* This field is required.By signing this form, I (the “Member”) hereby certify that all of the above information is correct and I agree to adhere and abide by the policies, procedures, conditions of enrollment as a member of the gym. Lumpini Combat International shall not be liable for any damages arising from personal injuries sustained by Member in, or about the premises. Member in attending the gym and using the facility does so at his/her own risk. Member assumes full responsibility for any injuries or damages which may occur to Member in, on or about the premises of said club and he/she does hereby fully and forever release and discharge Lumpini Combat International, it’s owners, employees, and agents from any and all action, present or future, whether the same be known or unknown, anticipated, resulting from or arising out of the negligence of Lumpini Combat International, or its owners, employees and agents, or negligence of any persons present on said premises as guest of members. You agree that if you feel lightheaded, dizzy, nauseous, or experience pain or discomfort at any time during a training session, you will immediately stop the activity and inform your Personal Trainer or Group Instructor. You agree to inform your instructor/trainer of any conditions or changes in your health at any time while participating in the program, which might affect your ability to exercise safely and with minimal risk or injury. Memberships are not transferable. Membership fees are not refundable.

Lumpini Combat - Registration Form!