Chi Kung - renouvellement

Centre communautaire de Roxboro

19 rue Commercial, Roxboro, QC H8Y 2N9 * taichimontreal@gmail.com
Chi Kung * Renouvellement *Register & pay online
If you want to arrange payment over the phone or in person

please click >> ChiKung Renewal registration Arrange Payment
Prenom Nom de Famille*

First NameFamily name
Email *
example@example.com

Merci d'indiquer tout changement afin que nous puissions mettre à jour votre fichier / Please indicate any changes so that we can update your file. *

	Qui	Non
Votre adresse ou téléphone a-t-il changé depuis le dernier renouvellement? Has your address or telephone changed since last renewal
Avez-vous eu des changements de santé depuis votre dernier renouvellement? Have you had any other health changes since last renewal?

Veuillez enregistrer toute modification ou information supplémentaire. Please record any changes or additional information.

Select terme * Renouvellement/Renewal*

	6 class session	3 (6 class Sessions)
Chi Kung (select if you are ALSO registered to either a class in Tachi or Kung Fu at the Center) Basically Qigong would be your 2nd program membership.
Chi kung (select if you are NOT taking classes in Tai Chi or Kung fu member)

Step # 2 Option de paiement / Payment Option
Comment voulez-vous payer? / How would you like to pay?

Online (payer maintenant avec carte de crédit. Paying now with credit card)
Total cost $
If you chose in-person, please see administration the next time you are in the office. Merci

Step # 3 Lisez / read > Termes et Conditions
Terms and Conditions - Francais et English

*Please note that all program fees are. noted on the individual registration forms and updated there. They are not necessarily always updated in the terms but are in the registration forms.
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.*

Oui / YES

Step #4 Veuillez confirmer votre inscription / renouvellement. Confirm your registration / renewal
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*

Oui / Yes
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Centre communautaire de Roxboro