Membership AgreementPlease fill out the form below prior to coming to your first class. Name of Buyer/Member * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Name of Member 1: * Date of Birth for Member 1: MM DD YYYY Name of Member 2: Date of Birth for Member 2: MM DD YYYY Name of Member 3: Date of Birth for Member 3: MM DD YYYY Billing Information * Please enter your CC, Expiration Date, CVV, and Billing Zip Code below. Please review: * *Buyer certifies that the member is in good health. *Enrollee of Martial Arts should take promotion tests upon recommendation of the instructor. *Buyer is liable for all injuries sustained at the facility. *Uniforms, seminars, testings, tournaments, etc. are separate fees not included in the terms of this agreement. *This agreement comprises the entire agreement pertaining to membership, and no other agreement of any kind will be recognized by us. I acknowledge to have read (or to have read to me) the terms of this agreement in its entirety. By checking this box, I understand that I will be placed on autodraft. I will give 30 days notice to stop payment and understand that Ballantyne Kicks does not offer refunds. Thank you for your submission! We look forward to seeing you in class!