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Employee Application
CHILDREN'S SUCCESS SEMINAR
Student Enrollment Agreement - On-Line
International Martial Arts Academy USA HEADQUARTERS – 6225 N. Federal Hwy - Fort Lauderdale, FL – 33308 - Ph: (954) 564-1119 –
IMAAUSA.com
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Student Name
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First
Last
Email
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Address
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City
State
Zip Code
Country
Phone Number
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Date Of Birth
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PROGRAM LENGHT
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12 Months: 169.99 per month (Most Popular)
6 months: $189.99 per month
Registration $ 200 (includes Judo Uniform Pack. Jacket, pants, belt and IMAA Patch)
Payment Authorization
I Authorize
International Martial Arts Academy
to deduct from my credit card/bank account reflecting upon the information stated in the payment information:
Credit Card
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Visa
Mastercard
American Express
Other
Card Holder
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Credit Card Number
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Expiration Date
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Security Code
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The student, parent or guardian understand that, all payment in full or past due are not refundable, that the regular, hourly tuition is $150.00 per hour, but a substantial discount has been provided by virtue of enrolling in a regular course. The student, further, understand that failure to complete these lessons does not relieve him/her of the obligation to pay the tuition in full. The students recognize that IMAA has made a substantial commitment in terms of staff and facilities in order to provide competent levels of instruction in the martial arts and therefore acknowledge a corresponding commitment on his/her part to fulfill the obligations under this agreement. For your convenience this is an ongoing agreement and will be automatic renewed for the same number of months unless the undersigned will send a no renew notice 30 days prior the last month of billing. All late payments will be subject to $ 15.00 late fee.
I have read all the terms set forth on the reverse of this agreement and acknowledge full responsibility to the terms and conditions stated herein as required for membership.
This form of payment, if discontinued, does not release you from your payment obligation or membership agreement.
Today's Date
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Signature (or guardian under 18)
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