Name____________________________________________________________________________ |
Parent's
Name____________________________________________________________________ |
Address__________________________________________________________________________ |
City/Zip__________________________________________________________________________ |
Home Phone __ __ __ __ __ __ __ __ __ __Work Phone __ __ __
__ __ __ __ __ __ __ |
Cell Phone __ __ __ __ __ __ __ __ __ __
E-mail_______________________________ |
Participant's Date of
Birth_____________________________________ |
|
Payment: $595, Check, Cash or Credit Card (Visa__
MC__)
|
|
Make checks payable to Karate Life
Skills |
Credit Card # __ __ __ __ __ __ __ __ __ __ __
__ __ __ __ __ exp.______
|
Referred
by________________________________________
|
| ... |
|
Schedule |
|
Please circle the
session of your choice. |
| ... |
Spring Session: Classes meet on Mondays or Wednesdays.
Please circle your choice of day and time.
. |
Beginning Monday, March 29, 2010 - 4:30
PM
|
Beginning Monday, March 29, 2010 - 5:30
PM
|
Beginning Monday, March 29, 2010 6:30
PM
|
| |
Beginning Wednesday, March 31, 2010 - 5:30 PM |
Beginning Wednesday, March 31, 2010 - 6:30 PM |
|
|
Print this form, fill it out and mail it to:
Paul Sweetow
North Shore Karate Center
1050 Gage Street
Winnetka, IL 60093
Or, if using a credit card, fax it to
847.441.0916 |