RETREAT REGISTRATION FORM

14th ANNUAL SUMMER CAMP

Shadowcliff Mountain Sanctuary

Grand Lake, Colorado

JULY 31-AUGUST 5, 2017

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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 initial deposit ($250 triple; $305 double).

Initial deposit due by April 1, 2017.

Kim Kanzelberger               

5800 Lowell Rd.           

Merriam , KS 66202

 

Make checks payable to: Center States Tai Chi ChuanInitial Deposit is nonrefundable.  All other fees are nonrefundable after their due date.

Credit Cards (MC, Visa, Discover) accepted by phone.  Call 816-531-0065.

(Credit cards are subject to a 3% transaction fee, so checks are preferable)

 

Name______________________________________________________________

  

Address____________________________________________________________

 

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Phone(s)__________________________________hm_____________________________cell

 

Email ______________________________________ 

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