Hapkido Regular Class Registration

Hapkido Regular Class Registration

Your first month's tuition, and subsequent months' payments, will be taken by Member Solutions, the billing company used by Clemmons Martial Arts. By selecting how many family members will register below you authorize Member Solution to collect the tuition for the first month and all subsequent months Recurring Payments beginning next month. Payments can be made by a credit card draft ONLY. Payments will be made to Member Solutions, the billing company for Clemmons Family Martial Arts.
Name Of Student # 1 *

First Name Last Name
Age of Student *
Name of Parent/Guardian/Caregiver (if student is under Age 18)
Address of Student/Parent/Caregiver *

Street Address

Street Address Line 2

City State

Zip Code
Student/Parent/Caregiver Email *
example@example.com
Best Phone Number *

Area Code Phone Number
Name & Age of Student # 2
Name& Age of Student # 3
Number of Students to Register For Regular Classes *

1 Family Member at $100.00 3 Family Members at $260.00 2 Family Members at $180.00 4 Family Members $340.00
Credit Card Information

I understand the first month payment and the following recurring payments will be paid by the Credit Card listed below. This payment will be taken by Member Solutions, the billing company for Clemmons Family Martial Arts.
Bank Issuing Credit Card: *
Credit Card Number *
Expiration Date *
Security Code (CVC2) *
Postal Code *
Today's Date: *

Month Day Year
Date
Thank you for registering for Hapkido Regular Student Classes. We are glad you chose to continue training with us.
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Hapkido Regular Class Registration

Credit Card Information