Name:

Address:

City:   State:   Zip:

Phone (day): (cell):

Email:

Emergency Contact:

Relationship of Contact: Contact Phone:

___________________________________________________________________________________________________

For Workshops and Special Events Only

I am Pre-registering for a workshop. Which workshop? (Purchase on Events page)

I have pre-paid using Pay Pal on Events Page

I will pay later, cash and credit accepted in person

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For RegularClass Cards
Class Options:
1st Class - $5.00  
Drop in - $10.00  
5 Class Card - $45.00  
10 Class Card - $85.00

Payment Options: 
Cash    
Check (include check number)  

PayPal (Make a bullet here, then please use PayPal drop down menu below).

Is this a Gift Certificate:
Yes   Name on gift certificate:
No

When are you expecting to join us?(Date/Time)  

How did you hear about us?

May we add you to our contact e-mail list? Yes No