Membership Form

Is this a new, upgrade, or add-on membership?(Required)

Customer Name(Required)

Customer Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Primary Customer Phone Number(Required)

Secondary Customer Number

Email(Required)

Number of Students Being Enrolled(Required)

If you are also signing up for a membership, please include yourself.

Primary Student Name(Required)

Primary Student's Birthday(Required)

Gender(Required)

Untitled(Required)

Is Primary Student an Upgrade?

Additional Student #1 Name(Required)

Additional Student #1's Birthday(Required)

Additional Student #1's Gender(Required)

Untitled

Is Additional Student #1 an Upgrade?

Additional Student #2's Name(Required)

Additional Student #2's Birthday(Required)

Additional Student #2's Gender(Required)

Untitled

Is Additional Student #2 an Upgrade?

Additional Student #3's Name(Required)

Additional Student #3's Birthday(Required)

Additional Student #3's Gender(Required)

Untitled

Is Additional Student #3 an Upgrade?

Enrollment/Upgrade Fees(Required)

Your Recurring Single Tuition(Required)

Your Recurring Family Tuition (2 students)(Required)

Your Recurring Family Tuition (3 or more students)(Required)

Date of First Payment

Payment Plan?(Required)

Is your billing address the same as above?(Required)

Billing Street Address(Required)

Billing City(Required)

Billing State(Required)

Zip Code(Required)

Billing Phone Number(Required)

Second Billing Phone Number

Please select your method for payment for your membership fees.(Required)

Your Credit Card Number(Required)

Card Type(Required)

Expiration Date(Required)

CVV Code(Required)

Billing Zip Code(Required)

Bank Name(Required)

Routing Number(Required)

Account Number(Required)

Signature(Required)

I/We hereby authorize the designated billing company selected by the Academy to draw on the specified day of each month items (checks, electronic funds, charge card) for the purposes of paying Academy tuition dues, service fees, Academy belt rank exam fees, sponsored events, and other purchases associated with this Membership.
I/We hereby authorize the designated billing company selected by Tiger-Rock Martial Arts International, Inc. to draw items (checks, electronic funds, charge card) for the purposes of paying national dues, competition entry fees, certification fees, high rank testing fees, and other purchases associated with this Membership.
I/We understand that I/We are responsible for advising the Academy of any changes in my checking account or credit card information. I/We understand that should my credit card be declined or there be insufficient funds in my checking account, I/We will be subject to any additional fees allowed by state law for insufficient funds.

Signature Date(Required)

Comments

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Begin your journey now. Talk to us about taking a class at our academy today!

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Membership Agreement

Membership Form

Begin your journey now. Talk to us about taking a class at our academy today!