Individual Registration

Please enter information in the form below to process registration for event Ladies Brazilian Ji-Jitsu Classes.

First Name *

Last Name *

Email *

Mobile Number *

Gender

Female

Male

Medical Conditions/Special Needs

Emergency Contact Information

DECLARATION: “I promise to uphold the martial arts I am taught. I promise never to use the skills that I am taught against any person, except for the defence of myself, my family or friends in the instance of extreme danger or unprovoked attack, or in the support of law and order".

Payment Information

Amount

Payment Method *

Stripe Checkout Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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