Capoeira Canal - Aplication Form Monday + Friday

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Capoeira Canal
335 Westbourne Park Road
London W11 1EG

Eight week courses training 2 times a week

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

Starting23 June 08 
Starting4 April 08 
Starting15 Sept 08 
Starting27 Oct 08 

Normal rate£112 Con£92 
Normal rate£96 Con£80 
Normal rate£96 Con£80 
Normal rate£112 Con£92 

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

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