Tai Chi Class Interest and Contact Form

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Tai Chi Class Interest and Contact Form

Interested in learning about and practicing Tai Chi! Our new Tai Chi class at FAIHP is for you! Fill out this form to let us know your contact info and skill level so we can send you reminders about classes, as well as adjust instruction to meet your needs!

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Name

Your answer

How familiar with Tai Chi are you?

Not very

1

2

3

4

5

Very much

Clear selection

How would you rate your mobility skills?

Not very

1

2

3

4

5

Very much

Clear selection

Do you have any particular physical issues you'd like this class to help with? (ie: arthritis)

Your answer

Email

Your answer

Phone Number

Your answer

Best way to contact you

Email

Phone

Other:

Clear selection

Submit

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