St. Louis Ki Society - Registration /Information Request Form

Saint Louis Ki Society
6006 Pershing Avenue
St. Louis MO 63112
(314) 726-5070
info@stlki.org

Mark Rubbert,
Executive Director
Above Address & phone
markrubbert@stlki.org

Sue Shepard,
Lead Instructor for Meramec Valley Ki Society (at Riverchase of Fenton)
(636) 274-9880
sueshepard@earthlink.net

Registration /Information Request Form

* Required fields

* Name

Street Address

City/State/Zip

Phone

* E-mail

Interests (check all that apply)

Please put me on the E-mail Newsletter mailing list so I can receive information about special activities and offers.

Adult & Teen Aikido

Children & Youth Aikido (ages 5 to 13)

Special Programs for "at risk" and disadvantaged children

Programs for Businesses and Organizations

Older Adults

Registration Information/Additional Comments

If you are registering for a specific class or program, please describe it in the box below and be sure that all contact information is correct.