610-574-1686
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If you wish to Fill out and Print the Application CLICK HERE

Required Fields*
*Name: * * *Home Phone:
Address: City: State: Cell Phone:
Occupation: Employer: How Long: *Date:
*Who are the lessons for: *Age: *Relation to you: *

Previous Experience.
Have you trained in Martial Arts Before: Yes: No: If yes where? How Long? Rank?
Have you done KickBoxing or Pilates before: Yes No If so were? How Long?

Your Goals:
What do you want to accomplish from your training here? Check all that apply.

Fitness | Weight loss | Muscular Strength | Cardiovascular | Increased Flexibility | Stress Relief
Self-Disipline | Self-Confidence | Self-Defense | Any Others?

If you are accepted how long are you willing to work to achieve your goals?

Any Questions about Training? Any Medical Conditions that would limit your ability to train?

Are you currently involved in the fitness industry? If yes Were? How Long?

Comment Box:

Contact American Karate System
Mailing Address:
44 W Chestnut ave
Merchantville, NJ
United States of America
08109

Telephone: 610-574-1686
Email: mrschiffman@americankaratesystem.com
Website: www.americankaratesystem.com
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