Capoeira Canal - Aplication Form Friday

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Capoeira Canal
335 Westbourne Park Road
London W11 1EG

I would like to attend the following course(s) [please tick]

Starting8 Aug 08 
Starting19 Sept 08 
Starting31 Oct 08 
Starting9 Jan 09 

Normal rate£60 Con£48 
Normal rate£60 Con£48 
Normal rate£70 Con£55 
Normal rate£60 Con£48 


I enclose a cheque (made out to Capoeira Canal) for £

Name:...............................................................................
Address:.............................................................................
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Email:..............................................................................
Phone:..............................................................................