Waiver

PRMAA Membership*

New Member
Renewing Member
Upgrade

Welcome to the Pacific Rim Martial Arts Academy. Before participating in any event, class, or activity, you must first complete and submit this form in it's entirety. You may complete this form for yourself and any immediate family members who are part of your membership. Before completing the form, please indicate whether you are a new or returning member of PRMAA.

Enrollee Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth

Age

Please enter a number less than or equal to 100.

Gender

Male
Female

Primary Phone

Alternate Phone

Email

Employer

Occupation

Friend or relative not living with you:

First Last

Phone number for contact above:

OPTIONAL: Use the fields below to add additional family members to your membership.

Name

First Last

Date of Birth

Age

Please enter a number less than or equal to 100.

Gender

Male
Female

OPTIONAL: Add a family member

Name

First Last

Date of Birth

Age

Please enter a number less than or equal to 100.

Gender

Male
Female

OPTIONAL: Add a family member

Name

First Last

Date of Birth

Age

Please enter a number less than or equal to 100.

Gender

Male
Female

PRMAA Waiver & Terms

Step 1 of 3

OPTIONAL: Use the fields below to add additional family members to your membership.

OPTIONAL: Add a family member

OPTIONAL: Add a family member

MEDICAL HISTORY