APPLICATION FOR ANNUAL INTERNATIONAL CQB COURSE

Name: ____________________________________________________________

Phone (home): _____________________   (work): ____________________

Address:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________


This is a certified course. Course Fee - non members $550.00.
Limited positions. Accomodation and lunch costs available on request.

Deposit required to ensure place on course $250.00 (non-refundable).

Full refund to all unsuccessful applicants. Please include with application
plus a brief background description.

Return with payment to:

                      School of Self Defence
                            PO Box 5579
                              Dunedin 9058
                            New Zealand

                      Phone/Fax: 03-477 8902