Please note that this is an update to the 2011 Sword Class Schedule:

   2011 SWORD FORM with William C.C. Chen Th(Y)-5:30pm – 6:30pm
                    On designated dates only
   Sep 1, 8, 15 ~~Oct 6, 13, 20, 27 ~~Nov 3, 17 ~~Dec 8, 15, 22

                         SWORD FORM REVIEW
       2011~Dec 29 ~~~2012~~Jan 5, 12, 19 ~Feb 2, 9, 16

We reserve the right to modify and update this information as needed.

P R I N T or T Y P E - BILLING ADDRESS
Name
                                            
Address
                                                  
City / State / Country

home #
                                                  cell #
   
    Visa [ ] MasterCard [ ]
 
Account # -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -
                     
Expiration: Month _____ Year _____ 3 Digit Code: __ __ __

Today's Date _______________ I authorize the amount of $ ____________
 
  X_________________________________________________________
                 Sign and Print full name

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Class Date and Time(s)
(Th) 5:30pm to 6:30pm -- On designated dates only --
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Class(es) for:
INSTRUCTOR: William C. C. Chen
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Location
William C.C. Chen Tai Chi Chuan, Inc. - 1 East 28th Street - 7th floor - New York, NY 10016
ph: 212-675-2816

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Option 1 --- Scan & Email completed copy of this form to WmCCChen@aol.com
Option 2 --- Fax completed form to 212-677-5352
Option 3 --- www.Paypal.com make payment to email: pslwsv@aol.com