Please reserve my spot for this J.R. Roy Martial Arts Event

Event Name and Date ______________________________________________________

Your Name ______________________________________________________________

Address _________________________________________________________________

City _____________________State_______ Country________________Zip___________

Phone Home ( ___)____________________ Work (____)__________________________

E-mail address ___________________________________________________________
May we contact you by e-mail for J. R. Roy Martial Arts functions?____________

Your main instructor(s) _____________________________________________________

Years total Martial Arts experience (no experience necessary, unless noted) _________

Active ranks, please include style & principal instructors __________________________
_________________________________________________________________________
_________________________________________________________________________

Weekend events: Full Package __ Other ______________________________________
Notes and special considerations:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Amount enclosed $_______________
Please make check to:
J. R. Roy Martial Arts
Send to:
J. R. Roy Martial Arts
1 Osgood Street
Gfld, MA 01301