2024 POOMSAE SEMINAR

JUNE 15: TAEGUK 1-PYONGWON JUNE 16: SIPJIN-ILYEO

Father's First & Last Name

Father's Email Address

Father's Phone Number

Mother's First & Last Name

Mother's Email Address

Mother's Phone Number

Member Name 1 *

Member Name 2

Member Name 3

Belt Level of Member 1 *

Belt Level of Member 2

Belt Level of Member 3

Belt Level of Member 4

Price *

DAY 1 ONLY: $100

DAY 2 ONLY: $100

DAYS 1 & 2: $200

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Signature *

clear

Customer Agreement *

Yes, I approve of application fee and services

310 N 21ST STREET, PURCELLVILLE, VA