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Silent Dragon School of Kung Fu and Tai Chi

 

First Name:                            Last Name:                            Hometown:

Please use:

 Full name       First name and last initial     Both initials     I wish to remain anonymous

Age:

Occupation:

Employer:

Would you like a reply to this? Y    N

Style/Subject(s) referred to in comments:

 Kung Fu     Tai Chi     Aikido     Chi Kung     Chin Na     Weapons     Children’s

 Self Defense     Philosophy     Stretching     Other_______________________

Specifics referred to in comments:

 Instructor     Instruction style     Equipment/Facility     Schedules/Locations

 Learning supports (i.e. videotapes, handouts)    Extracurricular Activities

 

Comments:  (A story perhaps)

 

 

 

 

 

 

 

 

 

Comments: (Please don’t quote me on this part.)

 

 

 

 

 

 

 

 

 

Signature__________________________   Date___________

 

 

 

 

 


 

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