Win-Win Kung Fu Academy 2713 Murray Avenue, Pittsburgh, PA 15217 Tel: 412-336-8898 www.winwinkungfu.com(net)

Summer Intensive Program Registration Form Please add $30 each week if register after April 30, 2016

Name:

Date:

Week

1 2 3 4 5

Dates

Weekly Tuition Late Charge after discount ($30) ($160)

Allergic to any food or things

July 11 - 15 July 18 - 22 July 25 - 29 August 1 - 5 August 8 - 12 Subtotal For non-current students

Registration fee

Total 20% Due at registration

amount

$60

Payment method (Circle one)

Cash Check PayPal: Credit Card

No. Signature: Name Date: Exp:

/

/

No.

email:

type

Visa Master Discover