Hello and Welcome to the sign-up process

Signing up is a very easy, this form will guide you through it. Your Gi and your Federation membership are included in the prices listed below. A form needs to be completed for each student, so if there are multiple students from the same household, each one will need a separate contract filled out.

Thank you

Sensei

Buyer's Information:

First Name:

Last Name:

Email:

Date of Birth:

Address:

City:

State:

Phone:


Student's Information:

If Buyer and Student are the same check here:

First Name:

Last Name:

Date of Birth:

Class Fees:

1st Adult

Payment Options:

2nd and 3rd Adults

Payment Options:

1st Youth

Payment Options:

2nd and 3rd Youth

Payment Options:

Payment Information:

Please select one (Checking, Savings or Credit) payment.

 

Select for Bank Payment:

Checking Savings

Routing Number :

Account Number :

Bank Name :

Bank City:

Bank State:

Select for Credit Card Payment:

Credit

Name as it appears on Credit Card:

Card Number:

Card Expiration Date

  I authorize my bank to debit my account as identified above to the terms stated here.  This authorization shall remain in effect until Heartland payment Systems and the bank receive written notification from me of intent to terminate at such time and such manner as to afford Heartland Payment Systems and the bank reasonable opportunity to act (Minimum 30 days)
  I understand that if the total amount owed to heartland Payment Systems is increased, I authorize this plan to continue as long as the payment amount remains unchanged until the amount owed Heartland Payment Systems is paid off, or unless the plan is terminated earlier by me as above.  I understand any added amounts can be applied for with a new authorization form.
  All other changes such as payment amount, frequency, bank account number change, will require a new payment Authorization form to be filled out and submitted to Maine Traditional Karate 15 days prior to any change being implemented.  I understand that this payment plan may be cancelled by Heartland Payment Systems or Maine Traditional Karate due to NSF (Non-Sufficient Funds).  I will be liable to pay an NSF fee of $25.00(or the amount allowable by law).
  I represent and warrant that i am authorized to execute this payment authorization for the purpose of implementing this payment plan.  I indemnify and hold Heartland Payment Systems, the bank, and Maine Traditional Karate harmless from damage, loss or claim resulting from all authorized actions hereunder.

Special Notes/Comments:

 

Instructors

Sensei Steve Apsega - Head Instructor

Head Instructor
Sempai Lou Keifer - Nidan Sempai Scott Daigle - Shodan Sempai Peter Bernier - Shodan
Sempai Joseph Isgro - Shodan Candice Kiefer Craig Nichols
Jody Layman Sempai Aaron Withers - Shodan Sempai Audrey - Junior Shodan
Sempai Dan Vilasuso - Junior Shodan Sempai Ashlee Vilasuso - Junior Shodan Sempai Lauren Grant - Junior Shodan

Our Partners

Contact Us

Please feel free to contact our dojo if you have any questions.

Address: 136 River Rd Orrington, ME 04474
Telephone: (207)-825-4048
FAX: (207)-825-4048
Others: (207)-570-5425
E-mail: sensei@mainetraditionalkarate.com

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