Thank you for your interest in the Wing Chun Do Association. Use the form below to request more information about our programs, products, services and upcoming events.

1. Name

First Name

Last Name

2. Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

3. Date of Birth

YYYY

4. Email Address

5. Cell Phone

Country

(###)

###

####

6. Martial Art Experience? Rank(s)/Certifications?

7. Do you own your own School/Academy? Name?

If "No" then skip to #11

8. Website?

http://

9. Number of students?

10. Is your academy within a 20 mile radius of an existing Wing Chun Do Academy?

Yes

11. Have you attended any seminars by James DeMile?

Yes

12. Are you or have you been affiliated with any Wing Chun/Ving Tsun programs?

13. What is your motivation for joining the WCD Association?

14. Which Info-Packet would you like to receive?

15. Questions?

Thank you!

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