First Name

Phone

Street Address

Name of person, if not you,
wanting to try our program

Age of person trying program

Last Name

E–mail

City

 
State

Zip

CHECK THE AREA THAT IS CLOSEST TO WHERE YOU LIVE
JACKSONVILLE, FLORIDA AREA:
 Arlington

 Monument/Regency

 Mandarin

 Hodges and Atlantic Blvd.

 Baymeadows

 Butler and Hodges
 Julington Creek

 Neptune Beach

 Ponte Vedra Beach

 Orange Park

 Wells Road

 Eagle Harbor
 Gainesville, Florida
SOUTH FLORIDA AREA:
 Ft. Lauderdale

 West Palm Beach
 Coral Springs

 Plantation
GREATER MIAMI, FLORIDA AREA:
 Cooper City

 Hialeah

 Miami Lakes
 Miramar (2)

 Pembroke Pines

 Weston (2)


(If you are under 18, please have a parent or guardian fill out this form.)

Once you recieve your savings certificate, you can contact any of our schools (check our location list for the school nearest you) and set up a convenient day for your FREE introductory school tour and program review to determine the training program that is right for you or your child. Our staff will show you all the benefits that Chief Master Clark's world famous ATA certified programs and instructors can offer.
©2009 Karate America     Website Powered By: Marketing By Design