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Emergency Contact (name & phone#):

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Please Choose One (only) of the following:

Option 2: 12 month membership
Pay $45 per month for 12 months (automatic monthly withdrawal)
Select One: Option 2: $45 per month for 12 months

Option 4: 6 month membership
Pay $54 per month for 6 months (automatic monthly withdrawal)
Select One: Option 4: $54 per month for 6 months

Option 5: 3 month membership
Pay full three months $189
Select One: Option 5: Pay full three months $189

Option 6: 1 month membership
valid for 30 days from the time membership is purchased
Select One: Option 6: 30 day membership $68.25

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Telephone

Class Date

Level One Class $345
 Level One

Level Two Class $280
 Level Two

Level Three Class $280
 Level Three

Level Four Class $280
 Level Four