![[Power 4 Women]](p4wstraight.gif)
Address: _______________________________ | City: __________________________________ | State/Zip Code: ___________________________ |
Phone - Day (_____)_______________ | Phone - Night (_____)_______________ |
e-mail: _________________________________ |
Basic Self-Defense Workshops | $35 per student ($25 for associate members) | |
Saturday, June 21, 9:30 AM to 12:30 PM | Number of Students: _____ | $_________ |
Thursday, June 26, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Friday, July 11, 5:30 PM to 8:30 PM PM | Number of Students: _____ | $_________ |
Monday, July 21, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Tuesday, August 5, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Wednesday, August 13, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Intermdiate 1 Self-Defense Workshops | $20 per student | Prerequisite: Basic Workshop Includes: Basic Side Block, Wrist Release and Choke Holds |
Saturday, June 21, 1:15PM to 4:15 PM | Number of Students: _____ | $_________ |
Thursday, July 17, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Saturday, August 9, 9:30 AM to 12:30 PM | Number of Students: _____ | $_________ |
Intermdiate 2 Self-Defense Workshops | $20 per student | Prerequisite: Basic Workshop Includes: Block Up and Down Mixed, and Ground Defenses |
Saturday, June 28, 10:00 AM to 1:00 PM | Number of Students: _____ | $_________ |
Saturday, July 26, Noon to 3:00 PM | Number of Students: _____ | $_________ |
Saturday, August 9, 1:15 PM to 4:15 PM | Number of Students: _____ | $_________ |
Intermdiate 3 Self-Defense Workshops | $20 per student | Prerequisite: Basic Workshop Includes: Block Straight Strike, Multiple Attackers, Attackers with Weapons, Home Weapons |
Saturday, July 12, 10:00 AM to 1:00 PM | Number of Students: _____ | $_________ |
Thursday, July 31, 5:30 PM to 8:30 PM | Number of Students: _____ | $_________ |
Saturday, August 23, Noon to 3:00 PM | Number of Students: _____ | $_________ |
| Associate membership (Optional) | Number of Members: _____ at $20 each Please give us names and addresses. | $_________ |
| Donation to the Scholarship Fund (Optional) | $_________ | |
Grand Total | $_________ |
| The self-defense workshops will be held at the Honey Tree Day Care Center 201 N. Clark St., Chicago. 2nd floor Up the stairs between Popeye's and Fishport, and turn right. |