EVENT REGISTRATION PAGE

PLUM BLOSSOM TAI CHI - ALBERTA

2013 SPRING TAI CHI RETREAT REGISTRATION

* Indicates required field

Name *

First

Last

Gender *

Email *

Phone Number *

Do You have experience in : *

Tai Chi / Chi Qong Fitness/ Weight training/ Yoga Martial Arts

Method of Payment *

By Phone using Credit Card-226-927-4569 Email Money Transfer - dsjchantal@yahoo.com Cash -in person (payment must be taken prior to event-please call)

Emergency contact- (Name/Telephone), Please Include any Physical Limitations: *

I do hereby voluntarily submit my application for admission to The Ontario Plum Blossom Martial Arts Academy for attendance and participation in lessons. Furthermore, I voluntarily consent that any picture furnished by me or any pictures taken of me in connection with Ontario Plum Blossom Martial Arts Academy may be used for publicity and/or promotion of same. Furthermore, I waive the right to any compensation in regard thereto. I understand that there are NO REFUNDS for any deposits,fees or tuition paid by me for the classes at Ontario Plum Blossom Martial Arts Academy, unless the classes or courses in which I am involved are cancelled or with medical notice from my physician. I also realize that I am responsible for payment in a regular and timely manner.

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