Wufoo

Crussemeyer's World of Martial Arts

Please fill out the following questionnaire to determine your eligibility for membership status at this education centre. Master Crussemeyer personally selects all prospects to be accepted as a Student in this school.

Prospective Students Name * First Last
Prospective Students Age *
Parents Name (if for child) First Last
Phone * ### - ### - ####
Alt Phone? ### - ### - ####
Optional Field. Fill this out if you have another number you would like to be reached at.
Email *

CWMA practices ethical email use. It's kept between us and you.
Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Most of our current members are referral only, how did you hear about us?
Briefly describe what you hope to achieve from training at our Dojang:
Do you feel Marital Arts are just about fighting? *
Yes No
Are you willing to humble yourself to accept instruction? *
Yes No
Do you agree that Education of the highest caliber in any given field of study is an investment in yourself? *
Yes No
When areas of your life become challenging, do you normally give up or do you work harder to become successful in those difficult areas? *
Quit Apply Myself
Do Not Fill This Out