U THE SAMURAI ENROLLMENT FORM Prefix*Ms.Mr.Student Name* First Last Warrior Name Confirm Class Dates:*Samurai: April 5-7, 2023Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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.