Matthews Location: 704-814-9966 | Charlotte Location: 704-847-1099 | Wesley Chapel Location: 704-821-0829

Payment for In-House Tournament Registration Sept 26 2015

Registration Date *

Your Location *

Student's Name 1 *

Age *

Current Belt *

Student's Name 2

Age

Current Belt

Student's Name 3

Age

Current Belt

Parent's First Name *

Parent's Last Name *

Phone *

Email *

Regular Participation *

Weapon Participation (Green Belt - Blue Belt) *

Optional

Weapon Participation (Red Belt - Black Belt) *

Mandatory

Demo Team Member *

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Type*

Card Holder Name*

Bank ABA Routing Number*

Bank Account Number*

Bank Account Type*

Bank Name*

Account Holder Name*

I accept Term and Condition

Introduction Video