U the Samurai Enrollment Form

"*" indicates required fields

Prefix*

Student Name*

First Last

Warrior Name

Confirm Class Dates:*

Address*

Street Address Address Line 2 City State ZIP Code

Mobile Phone*

Email*

Job Title*

Company Name*

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Email*

Who referred you to U & Improved?*

Refunds & Rescheduling Policy*

I have read and agree to the terms of the Refunds & Rescheduling Policy.

Refunds: We do not issue refunds. Please notify us within 14 business days if you need to reschedule your class date to avoid a rescheduling fee. Rescheduling: All classes are subject to a rescheduling fee of up to $350. To avoid the fee, please notify us within 14 business days of the class start date that you need to reschedule.

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U THE SAMURAI ENROLLMENT FORM