Black Belt Pre-Test  page 2

You Must RSVP:

Please contact the school to advise us if you will be attending or not attending this pre-test.  You may fax your RSVP to the studio by checking (Yes) or (No) at the bottom of this form.

Note:  You MUST attend THIS Pre-test in order to attend the up-coming Black Belt test!  Students that do not attend THIS Pre-test, WILL NOT be eligible to take the Black Belt test.

Please check items below you will need.

Black Book $25     Yellow Book $50   Web Access $45   DVD $50

Yes I will be attending $65  No I will not be attending  (Fax) 482-1896

Name of Student (Please Print) ____________________________  

Name on Credit Card___________________________________    

Credit Card Number  ____________________________________

Exp. Date: _________

Amt. $____________

Zip Code your cc is billed to: __________

Signature ___________________________

Please Fax to 561-482-1896