Free Self Defense Class

Free Self Defense Class Registration

Please fill out the form below to register for the free self defense class. Fill out a separate form for each person attending.

full name:
preferred name:
age: (this information is used primarily for statistical purposes.)	under 18 (requires parent/guardian) If you are under 18, please indicate your grade level. 19-25 26-35 36-49 50+
email address:
mailing address:
Evening phone number with area code.
Which class will you attend?	Saturday, May 15, 1-4pm. Sunday, May 16, 2-5pm class is CLOSED.
How did you hear about Hand To Hand?	(Select all that apply; use CTRL-click to select)
Please enter any additional information in the box to the right. Include a description of any prior training you have in self defense or martial arts. Please list any medical conditions or disabilities which might affect or limit your ability to participate in this course. Please list names and ages of other participants with whom you will be attending (each individual must fill out a separate form).