Self defense workshops for older adults: Registration 老年人自卫研讨会：注册表格
You are registering for a one hour self defense workshop for older adults.
Location: Tat Wong Kung Fu Academy, 4801 Geary Blvd, San Francisco, CA 94118
(corner of Geary and 12th)

Contact us at: onerichmond@richmondsf.org or (415) 683 8402
For monolingual Chinese speakers please contact: Sarah Li, Neighborhood Resource Coordinator ‭(510) 821 1841‬
Alternatively, fill out a hard copy form at 802 Clement Street. 

您正在报名参与一小时的老年人自卫工作坊。

地点：Tat Wong功夫学院--位于加州旧金山市Geary Blvd 4801号，邮编：94118（Geary街和12th街交界处）。

联系我们：onerichmond@richmondsf.org 或 (415) 683 8402

如需中文服务，请联系：Sarah Li，社区资源协调员，电话：‭(510) 821 1841‬。

另外，您也可以在802 Clement Street 团结列治文办公室填写纸质表格。

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Email *
Participant's first name: 名字
Participant's last name: 姓氏 *
Are you registering for a monolingual friend or relative? 

您是帮助非英语的朋友或亲属报名吗？
If yes, what is your name and contact details?  如果是的话，请填写您的姓名和联系方式

Contact phone number: 联系电话： *
Street Address (priority given to Richmond District residents in 94118 and 94121)
 街道地址（居住于列治文区邮政编码94118和94121的居民优先） *
City 城市 *
Required
State 州 *
Required
Zip Code 邮政编码 *
Required
Birthdate MM/DD/YY 出生日期（月/日/年） *
MM
/
DD
/
YYYY
Race/Ethnicity 种族/族裔 *
Required
Gender 性别 *
Required

How do you describe your sexual identity or sexual orientation? 
您如何描述您的性身份或性取向？

 *
Required

Primary Language spoken at home 
家庭中使用的主要语言中文-粤语


 *
Required

Number of people in family at home address 家庭住址的家庭成员人数

 *

Total family income 家庭总收入

 *
Required
Household Information 家庭信息：
 *
Required
How did you hear about this event? 
您是如何得知此次活动的？ *
Required
Are you monolingual and require Chinese only instruction?
您需要中文教学吗？
Clear selection
Please indicate dialect
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Which workshop can you attend? Please check your first and second choice. We will confirm your workshop date by email.  您打算参加哪个时间的研讨会？请选择您的第一志愿和第二志愿。我们将通过电子邮件确认您的研讨会日期。 *
Required
Comments and/or questions 评论和/或问题
I agree to be added to The Richmond Neighborhood Center's One Richmond email newsletter list or WeChat Group. You can unsubscribe anytime. 
我同意加列治文中心的 One Richmond 团结列治文电子邮件通讯列表或微信群。您可以随时取消订阅。
A copy of your responses will be emailed to the address you provided.
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