WE TRAIN HARD,
AND WE TRAIN TO WIN
KARATE | SELF
DEFENSE | SHO-BO
| AROBICS | KICK
BOXING |
AND INTRODUCING
THE AMERICAN STREET SELF DEFENSE SYSTEM
NAME____________________________________________________________________ AGE___________
ADDRESS_____________________________________ CITY______________ STATE________
ZIP__________
PHONE____________________ D.O.B._____________ OCCUPATION_________________________________
EMAIL________________________________________________ RANK_______________________________
MARTIAL ARTS
EXPERIENCE___________________________________________________________________
INSTRUCTOR_______________________________________________________________________________
SCHOOL___________________________________________________________________________________
WAIVER
SIGNATURE_________________________________________________________________
CO-SIGNER
(IF UNDER 18)_____________________________________________________
DATE____________