Student Booking & Inquiry Form
www.agkk.com.au/www.australiangojukaikarate.com
Please enter in your details below. Select your preferences and leave the other sections blank. (Please Note: Sections marked with an asterisk " * " must be filled in)
Name:
*
Age:
0-5
5-10
10-15
15-20
20-25
25-30
30-35
35-40
40-45
45-50
50-55
55-60
60-65
Gender:
Female
Male
Phone:
*
Email:
*
What type of Karate Lesson would you like to book that interests you?
1) PUBLIC CLASS:
None
Please contact me first. I would like more information.
Sandgate Town Hall Tues 4:30 to 6:00 pm
Sandgate Town Hall Tues 6:00 to 7:30 pm
Sandgate Town Hall Thurs 4:30 to 6:00 pm
Sandgate Town Hall Thurs 6:00 to 7:30 pm
Hendra Parish Hall Monday 7:00 to 8.30 pm
Hamilton Town Hall Wed 6:00 to 7:30 pm
Will this be your first lesson at Club AGKK?
None
Yes, I would like a Free Trial Lesson
No, I am booking a casual lesson only
I would like information on Special Discounts
2) PRIVATE LESSON: (Inquiry only. We will contact you to arrange a lesson)
None
1. Polish Your Form & Kata
2. WSD Tactical Response
4. Meditation & Relaxation
5. Introduction to the Spirit
6. Life & Goju Philosophy
7. Oriental Healing
8. Power Development
9. Kumite Instruction
10. Grapples & Holds
11. Weapons Instruction
12. Advanced Techniques
13. Spirit & Energy Channeling
Day and date of Booking
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
DD/MM/YY
How many people will be likely to attend the class/private lesson?:
How do you prefer to be contacted?
Phone
Email
Enter time here
Please enter your preferred time for callback:
PM
Date
AM
Comments: (Max. 150 words)
Please provide your email address for this form to be processed