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(Please Print Form and Attach Payment)
Price: $330.00 Participants
$225.00 Non-participants (No Infants)
All fees due by May 20 th, 2008
Send check or money order to:
Beth Moore
PO Box 245
Ormond Beach, FL 32175
Make all checks payable to: NATSU KEIKO
2008
*Payments are due no later than May 20th.
Please bring your own bed linens, pillows and towels.
NO PAYMENT WILL BE ACCEPTED AFTER MAY
20th.
Name:
___________________________________________________________________
Age: _____________________________
Rank: ________________________
Address
__________________________________________________________________
City/State:
________________________________________ Zip:
_________________
Phone:
(_____)_________________________ Email:
___________________________
Instructor: ________________________________________________________________
Emergency Contact:_________________________________________________________
Emergency Contact Phone: (______) __________________________________________
CAMP T-SHIRTS
pre-order only: I wish
to reserve (____) camp t-shirts of size ( S - M - L -1XL - 2XL) circle
one
Please indicate whether you are a Child or an Adult (circle
one)
An Important note to Parents: If you are sending your child to camp and are not going to be present yourself, please provide a hand written notarized note to your child's instructor granting your child's instructor "permission to treat" in which permission is given to have treatment rendered at a medical facility should it be necessary. |