Sword Form Seminar- Inscription

Centre communautaire de Roxboro

19 rue Commercial, Roxboro, QC H8Y 2N9 * taichimontreal@gmail.com
Sword Seminar
Prenom Nom de Famille

First NameFamily name
Telephone #
Format: (000) 000-0000.
Email

Rows	Qui Yes	Non No
Avez-vous des problèmes de santé / médicaux? Do you have any health conditions or concerns?

S'il vous plaît élaborer sur toute réponse OUI ci-dessus. Le plus d'informations le mieux, nous sommes là pour vous aider.
Please elaborate on any answer YES above. The more information the better, we are here to help you
Personne à contacter en cas d'urgence

Prénom /First Name Nom/Last Name
téléphone d'urgence/Emergency #
Format: (000) 000-0000.

Select Dates; Please make sure to check your availability & note your calendar before selecting as there are no refunds for this seminar. Please also note that there are so many spaces for this seminar ( room is only so big) Please register now to avoid disappointment. Times for each session are 830 to 1030 am and 1200 to 300pm

Rows	$50 / class
#2 session of 2 ; lDated for March 28, 2026

Total $

Total cost $
If you chose in-person, please see administration the next time you are in the office. Merci

Total cost $

CAD

Paiement / Payment Information

Terms and Conditions - Francais et English

*Please note that all updated registration fee's are on the registration form. The terms do not always reflect the updated registration fee's . Please go by what the form states
Je déclare avoir lu et compris le document précité et accepte mes droits et obligations tels que précisés. / I declare that I have read, understand and accepted my rights and obligations stated above in the Terms and Conditons.

Presque fini ! * Almost done!
En cochant la case ci-dessous, je comprends que cela représente ma signature électronique légale et qu'elle est juridiquement contraignante.

By selecting box below I understand that this represents my legal electronic signature and that it is legally binding.
J'ai indiqué ma signature électronique / I indicate my electronic signature
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Centre communautaire de Roxboro

Sword Seminar

Total cost $

Paiement / Payment Information

Presque fini ! * Almost done!