Class Registration

By clicking Register, I hereby release Inner Research Institute (IRI), all instructors and all other students of IRI, for any and all liabilities for any type of injuries or loss sustained while training, studying, practicing, or in the application of T’ai Chi. I also state that I am in good physical condition and know of no reason why I cannot study and participate in T’ai Chi.

Please note: Form won’t send if any boxes below remain empty.

Date

Full Name

Current Age

Mailing Address

City

State

Zip

Phone

Occupation

Past Experience of T’ai Chi or Martial Arts Training (Style, Teacher, When, and for How Long)

Any Physical Limitations Or Medical Conditions?

Emergency Contact Person

Emergency Phone Number

How did you hear about IRI?

Referred by (enter none if no referral)