RETREAT REGISTRATION FORM

7th ANNUAL SUMMER CAMP

Shadowcliff Mountain Sanctuary

Grand Lake, Colorado

AUGUST 2 – 7, 2010

 

Space is limited, so if you want to be sure of a spot, register early.

 

To hold a space in the retreat, print this page and mail with your $100 initial deposit ($180 for a double).

Initial deposit requested by March 1, 2010.

Kim Kanzelberger               

5800 Lowell Rd.           

Merriam , KS 66202

 

Make checks payable to: Center States Tai Chi Chuan

Initial Deposit is nonrefundable.  All other fees are nonrefundable after their due date.

 

 

Name______________________________________________________________

 

 

Address____________________________________________________________

 

____________________________________________________________                   

 

Phone(s)__________________________________hm_____________________________cell     

 

____________________________________ wk

 

Email ______________________________________ 

Can I list your email address on the class roster that is given to all participants?    Yes    No