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Request a Self-Defense Workshop
Name of Organization or Department
Contact Person
Please tell us who to contact about this workshop request. Include first and last name.
Phone Number
The phone number of the contact person.
Email
The email of the contact person
What type of program would you like to schedule?
Empowerment Self-Defense Workshop
Coed Self-Defense Workshop
Date Range
We request at least two weeks notice to schedule classes. What is the date range you would like to offer the class?
Preferred Day of the Week
What days of the week work best for you? Please select your top two options.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred Start Time
When would you like the workshop to start? Please list your top two options. Note that workshops on Mondays–Thursdays can only start after 3:00 p.m.
Number of Participants
How many participants are you expecting? We require a minimum of eight participants to hold a class.
Participant Demographics
Please describe the demographics of your group. Include any special needs or accommodations needed for group members.
Group Goals
What are the goals of the group for this workshop?
Questions or Comments?