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Registration Form. Fill out and send.
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| Name: | Date: | ||||
| Address: | |||||
| City: | State: | Zip: | |||
| Phone(Home): | (Work): | ||||
| Email: | |||||
| Emergency Contact: | |||||
| PRICE(Per person) | |||
| Per Class | $10.00 | ||
| Registration | $45.00 per day | $100.00 entire weekend | |
| ***Fee for the BIG3-VII is not included in the any of these prices!**** | |||
| PASSES(check one only ) | 1 DAY | 2 DAY | A la Carte (Pay by class) |
| Are you a:(check one only) | Lead | Follow | |
| Classes Attending: | |||
| Total Classes: |
Total Amount Due:
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| (Please list the classes you are most likely to attend, to help determine class size and lead/follow ratio. If you are paying by class: After listing the classes you will be attending, then list the number of classes and the total. Only list the number of classes and total amount paying if you do not choose the day or weekend pass option. You can pay at the door, but for speedier processing (so you don't have to wait in line), this form is best received earlier.) | |||
| Make your check/money order payable to : Kelly Palmiter | |
| Send your registration (and optional payment) to: | |
| Kelly Palmiter 450 Coachman Drive #2A Troy, MI 48083 |
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| Contact info: | Kelly Palmiter |
| cell: | (248) 703-2079 |
| email: | [email protected] |
OFFICE USE ONLY
| Number of days attending: | Amount Paid: |
| Entered: | Accepted(Date): |
Last Updated: Friday, July 12, 2002 2:08 PM
