SDC Family Option C

NOTE: The signer on this registration must be an adult aged 18 and older. If you are signing up on behalf of a minor, list their information under the fields marked “Participant.”

A $250.00 non-refundable deposit is required to reserve your place in class. You will have seven (7) days from the date of your registration to visit the front office of Martial Arts World to pay the difference remaining on your enrollment fee and complete your registration or you will forfeit this deposit.

Price:

$250 for 7 Days

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

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State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

D.O.B.:* D.O.B. is Required

Sex:* Sex is Required

Male Female

DLN:* DLN is Required

SSN: SSN is not valid

Cell Phone Number:* Cell Phone Number is Required

Alternative Phone Number: Alternative Phone Number is not valid

Participant Name (First and Last):* Participant Name (First and Last) is Required

Participant DOB:* Participant DOB is Required

Participant Sex: Participant Sex is not valid

Male Female

2nd Participant Name (First and Last):* 2nd Participant Name (First and Last) is Required

2nd Participant D.O.B.:* 2nd Participant D.O.B. is Required

2nd Participant Sex:* 2nd Participant Sex is Required

Male Female

3rd Participant Name (First and Last):* 3rd Participant Name (First and Last) is Required

3rd Participant D.O.B.:* 3rd Participant D.O.B. is Required

3rd Participant Sex:* 3rd Participant Sex is Required

Male Female

Emergency Contact Name - First and Last (Specify one other adult beside yourself that we can reach in the event of an emergency.):* Emergency Contact Name - First and Last (Specify one other adult beside yourself that we can reach in the event of an emergency.) is Required

Telephone Number:* Telephone Number is Required

Relationship to Participant:* Relationship to Participant is Required

Please upload a photo of your driver's license or state ID:* Please upload a photo of your driver's license or state ID is Required

I certify that I have read and agreed to Martial Arts World's Membership Terms and Conditions*

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Description	Amount
SDC Family Option C – Payment	$250.00
Total	$250.00

Select Payment Method

Pay With Credit Card Zelle Payment to 708-473-8179

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Pay with your Credit Card via Stripe Checkout

 

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