PRE-REGISTRATION May 15 9 :: $ 70 per person :: Saturday or Sunday ONLY :: (circle one) SAT SUN = $_____________$ 120 per person :: Full Attendance Both Days .. Saturday & Sunday = $_____________

AFTER May 15, 2019 & On-Site :: $ 80 per person :: Saturday or Sunday ONLY :: (circle one) SAT SUN = $_____________$ 135 per person :: Full Attendance Both Days .. Saturday & Sunday = $_____________

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CONTACT BRUCE LA CARRUBBA 862 268 6867 taichipark1@gmail.comwww.taichipark-masterjoutsunghwa.org

CHECKS PAYABLE TO :: Master Jou Birthday Celebration SEND CHECKS TO :: (to arrive before May 15, 2019)

(after May 15, 2019)

M

July13th - 14th, 2019

REGISTRATION FORM (each attendee must fill out & sign separately)

NAME :: ________________________________________________________________________________________

ADDRESS :: ______________________________________________________________________________________

CITY :: ___________________________________________ STATE :: ____________ ZIP :: _________________

PHONE :: ___________________________ EMAIL :: ____________________________________________________

* Please remember that we supply breakfast, lunch, & dinner on Saturday and breakfast & lunch on Sunday. While we try our best to accommodate all preferences please note that we may not be able to meet all dietary restrictions. Our fees seek only to cover expenses to host such an event. However in keeping with Master Jou's philosophy that no one be denied the benefits of Taiji/Qigong because of financial condition, and in accordance with his adage,"Do Your Best, Don't Overdo", these are the suggested EARLY REGISTRATION PRICES. If your finances don't allow for payment of these prices, please fill in what you can afford, in good conscience, and mail this form prior to the May 15, 2019 deadline.

In consideration of value received, I agree to assume full responsibility for any and all damages, injuries or losses that I may sustain, if any, while at the Master Jou, Tsung Hwa Birthday Celebration & Tai Chi Festival and do hereby waive all claims against the Owners, Agents, Staff, and any Instructors or Participants regarding all Liability, Claims and and Suits for any injury, fatal or otherwise.

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