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To Register for the next Tia Chi Class Print this page and mail this form along with your enrollment check to Donna Dixon PO Box 1020 Alcoa TN 37701
or Fax to Donna at Flatpik Central 865-982-3808
Name _______________________________
Address _____________________________
City________________________________
State_____________ Zip Code ___________
Phone Number ________________________
To guarantee your spot, deposits must be paid in advance of the class. If available, participants may register up the first day of class. Class size is limited. The fee is $80.00 for the eight week session.
Visa or Mastercard Number _______________________________________________
Expiration Date _______________
Signature____________________________________________________________
Your card will be charged by Steve Kaufman Enterprises, Inc and you will see that name on your credit card bill. Read and complete. Program Guidelines: Classed are open to suitable persons provided they are medically fit, are independently mobile and can participate without assistance in the class. The Tai Chi exercise in this program would be similar to walking in terms of physical exertion. Any participant who has any doubt whether they are medically fit to attend the class, is required to have a medial clearance from their physician prior to the first class session. Session usually last forty five minutes to one hour. Session are to start on time. Waiver I have read the Program Guidelines and I understand that there is an inherent risk in any exercise activities and I agree to abide by the rules set in the Guideline. I know that there are no medical reasons why I should not participate in this class or work shop. I understand if I do have any medial reasons why I should not participate in this class or workshop then its is my responsibility to obtain a clearance from my doctor before beginning.
Signature _____________________________ Date _________________________________ Fees are nonrefundable after March 20, 2008
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