U THE SAMURAI ENROLLMENT FORM Prefix*Ms.Mr.Student Name* First Last Warrior NameConfirm Class Dates:*October 25-27, 2019Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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. This iframe contains the logic required to handle Ajax powered Gravity Forms.