Please check the boxes of the seminars you want to attend:
__Taiji Single Fan __Kung Fu Single Fan __Taiji Double Fan
Fees
1 seminar
$80
$ _______
2 seminars
$130
$ _______
3 seminars
$180
$ _______
Late Registration Fee
(Postmarked by Sept. 15th)
$20
$ _______
Single Practice Fan
$20 each
$ _______
Double Practice Fan
$40 (Set)
$ _______
Total:
$ _______
Payment: Submit payment with this form. Enclose a check or money order, payable to "Jeff Bolt's Kung Fu & Taiji," or pay by __Mastercard or __Visa
Card No. ___________________________________ Expiration Date ___________________
Name on card __________________________ Authorized Signature ____________________
Send to: Jeff Bolt's Kung Fu and Taiji
9521 Westheimer, # 379
Houston, TX 77063
Refund Policy: Cancellations after September 15 are nonrefundable.
Location: The seminars are conducted in the large gym behind Westchase United Methodist Church located at 9603 Westheimer (next to Border's Books near the intersection of Gessner and Westheimer).
For more information
Call (713) 781-4483
Fax (713) 781-4487
Email: JeffBolt1@aol.com
Visit our website at www.JeffBolt.com