Rape Aggression Defense (RAD) Registration

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Session Fee is $95.

Class Times are for Tuesdays from 6:15pm - 9:15pm.

Please make checks payable and mail to:

Women's Self Defense Institute

518-7 Old Post Road, #234

Edison, NJ 08817

Class location will be distributed upon receipt of payment, but no later than 1 week prior to the scheduled class session. Class locations are kept confidential to ensure the safety and privacy of our participants.

RAD Registration Form

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone*
Home Phone*

Business Phone*
Business Phone*

Class Dates - Choose a Session*
Class Dates - Choose a Session*

	Session 10-1: January 5,12,19 & 26 2010
	Session 10-1A: January 6,13,20 & 27 2010
	Session 10-2: February 2,9,16 & 23 2010
	Session 10-3: March 2,9,16 & 23 2010
	Session 10-4: April 6,13,20 & 27 2010
	Session 10-5: May 4,11,18 & 25 2010
	Session 10-6: June 8,15,22 & 29 2010
	Session 10-7: September 7,14,21 & 28 2010
	Session 10-8: October 5,12,19 & 26 2010

How did you hear about our class?*
How did you hear about our class?*

Please enter the word that you see below.

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