R.A.D. Women's Self-Defense Class
For Women 15 and up. Led by Bryanne Gawlik.
Please complete the form below to indicate which session you will be attending. *$20 cost per person for booklet. *For Saturday session, please bring a bag lunch.
Choice of Session
*
Full Name
*
First Name
Last Name
Date of Birth
*
Age
*
Address
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact Name, Phone, & Relationship
*
Will pay $20 fee via:
*
Cash
Check
Parent/Guardian Name (Minors Only)
First Name
Last Name
Parent/Guardian Phone (Minors Only)
Please enter a valid phone number.
Parent/Guardian Signature (Minors Only)
Participant Signature
*
Submit
Should be Empty: