ISA Video Club Enrollment Form

ISA Video Club Enrollment Form Please print this form out and send it in to the address or fax number shown at the bottom.
NAME	________________________________________________________________________
STREET ADDRESS	________________________________________________________________________
CITY/STATE/ZIP	________________________________________________________________________
PHONE	________________________________________________________________________
EMAIL ADDRESS	________________________________________________________________________
INSTRUCTOR	________________________________________________________________________

CREDIT CARD TO BE CHARGED:
NAME ON CARD:	________________________________________________________________________
CARD TYPE:	________________________________________________________________________
CARD NUMBER:	________________________________________________________________________
EXPIRATION DATE:	________________________________________________________________________
LIST BELOW THE VIDEOS YOU'VE ALREADY PURCHASED IN ORDER THAT THEY WILL NOT BE SENT TO YOU: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
PRINT THIS FORM OUT, FILL IN ALL INFORMATION, AND SEND IT TO: International Shuri-Ryu Headquarters Attn: ISA VIDEO CLUB 2721 S Calhoun St Ft Wayne IN 46807 FOR FASTER SERVICE, FAX THE FORM TO: 1-260-744-0824

ISA Video Club Enrollment Form Please print this form out and send it in to the address or fax number shown at the bottom.

ISA Video Club Enrollment Form
Please print this form out and send it in to the
address or fax number shown at the bottom.