Enroll in a Smart Girl Self Defense Refresher Course

Only for those who already took the Smart Girl Self Defense course.

Email(Required)

Name(Required)

First Last

Both "First Name" and "Last Name" fields are required.

Phone #

I authorize Smart Girl Self Defense to notify me via SMS text messages:

Yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name(Required)

First Last

Both "First Name" and "Last Name" fields are required.

Emergency Contact Phone #(Required)

Participant Name(Required)

First Last

Both "First Name" and "Last Name" fields are required.

Participant Age(Required)

Parent or Guardian Name (If Under 18)(Required)

First Last

Both "First Name" and "Last Name" fields are required.

How did you hear about us?

Social Media/Internet

Friend/Co-Worker

TV Advertisement

TV KRQE

Print Advertisement

Do we have your permission to film or take pictures of you during the training sessions?(Required)

Yes

Comments for special consideration.

Participant Signature(Required)

Use your mouse or finger to draw your signature.

Parent or Guardian Signature (if under 18)(Required)

Use your mouse or finger to draw your signature!