Self Defense Six Week Course Registration

Self Defense Six-Week Course

When: Six Week Course Starting October 5th – meeting each Thursdays at 5:30 pm
Where: Pioneer Veterans Hall, 25100 Buckhorn Ridge Rd, Pioneer, CA

$80 per person After you press the SUBMIT button, you will be taken to PayPal where you can pay with a debit/credit card or a PayPal account. A PayPal account is not required.

For more information, call the ACRA office at 209-223-6359 or email bnichols@amadorgov.org

REGISTRATION FORM

Participant #1

Name *

First Name *

First

Last Name

Last

Address

Address Line 1

Address Line 2

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Email *

Would you like to add a 2nd person?

Yes

Participant #2

Name *

First Name *

First

Last Name

Last

Address – Leave blank if the same as Participant #1

Address Line 1

Address Line 2

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Email *

Pay Event Fees at PayPal (a PayPal account is not required)

Payments are submitted through PayPal. When you press the SUBMIT button, you will be taken to PayPal to process your fees. You do not need a PayPal account. You may pay with a debit or credit card at PayPal.

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