Self Defense Class Request

Name as you would like it to appear on the completion certificate. If more than one separate with commas. (required)

Email (required)

Phone Number (required)

Address (required)

City, State Zip (required)

Select Class (required)

Request Dates & Times (required)
Self defense classes require 2 hours and a minimum of 4 people. Classes are offered Tuesdays and Thursdays between 5:00pm and 9:00pm, or Saturdays between 8:00am and 5:00pm. Specify up to 4 Tuesday, Thursday, or Saturdays that would work for you in order of preference:

Date 1: Time:

Date 2: Time:

Date 3: Time:

Date 4: Time:

Additional Comments

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