CBLA Registration — Capoeira Brasil Los Angeles - Mestre Boneco

Capoeira Brasil Los Angeles

19th Annual Capoeira Festival

and Batizado

CBLA Registration

Name

First Name

Last Name

Nickname

Date of Birth

MM

DD

YYYY

Gender

Male

Female

Training Location

** If you train at CB Downtown LA, Orange County, or anywhere outside of Los Angeles, please register under (CB)

Current Cord

T-Shirt Size

Email Address

Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Special Notes