$20 OFF COUPON

... towards our KARATE Introductory Program

Classes available at our Putnam, CT location
- Mike Bogdanski's Martial Arts System -

PLEASE FILL OUT OUR FORM BELOW

First Name:
Last Name:
Address:
City:
State:	Zip:
Email:
Phone:
Gender:	Male Female
Birthday:
Age:
Do you have any physical ailments that might interfere with your training? Select: yes no
If yes, please explain:
Do you have any prior martial arts experience? Select: yes no
If yes, please explain:
HOW DID YOU HEAR ABOUT MIKE BOGDANSKI'S MARTIAL ARTS CENTER?
Yellow Pages?		Guest Class?
Advertisement?		Demonstration?
Radio Station?		Present Member?
Other?
WHAT ARE YOUR GOALS? (check all that apply)
Self-Defense?		Self-Confidence?
Physical Conditioning?		Relieve Tension/Stress?
Attention Span?		Weight Control?
Concentration?		Flexibility?
Self-Discipline?		Other?
Enter the Code: