Grandmaster Chen, Xiao Wang 2010 Registration Form
Early Pre-registration by Sept. 15, Cash only & full price after.
Please print and mail this registration form with your cash/check/money order payable to
Kim Ivy
1716 NW Market
Seattle, WA 98107
All money, once paid, is non-refundable.
Name
Address
City, State Zip
Phone Print Clearly Email
Please indicate sessions you wish to attend:
Laojia Only $360/$300 (early)
$360/$300
  
Whole Workshop $395/$335 (early)
$395/$335
Laojia per day $120/$110 (early) $120/$110  
Lecture $40/$35 (early) $40/$35  
Total Enclosed. Please remember to make checks to Kim Ivy, checks to Embrace the Moon will be returned and your registration will not be valid.
 
Please indicate your Martial Arts/Tai Chi/Qigong/Yoga/Meditation training, if any, current teacher if applicable & any special health concerns we should know about:

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