*Name:
*Email address:
*Phone number:
Select a Membership Option:
1 Month:
 3 Months:
Cardio Kickboxing Fitness Class
 ($50)
 ($130)
*Required Information
Contact Information:
Membership fees are appreciated on the first day of class.
www.burgesskarate.com
Cardio Kickboxing Classes
Payment of Fees
Cash or cheque is accepted
Cheques should be made out to Mark Burgess