Reusi Dat Ton
Level 1
Registration Form

Name

First Name

Last Name

Email

Phone

Country

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

If you have studied Reusi Dat Ton before, please note when and who your instructor was

There will be two times offered each Monday from Oct. 12th - Nov. 30th. Students are required to attend one of these sessions each Monday

I understand and anticipate being present for all classes

If you are alter-abled, have learning differences, or physical challenges please let us know so that your instructor can be prepared to give you the best guidance possible

Do you anticipate being pregnant during the time of this class?

Is there anything else you would like us to know prior to working with you in class?