Registration
Form
Name:
_________________________________
Address:
_________________________________
_________________________________
Age:
_________ Male / Female (circle
one)
Level
(circle one):
Beginner
Adv. Beginner
Intermediate Advanced
Parents
names: _____________________________
Home
phone: ___________ Cell phone:
____________
Emergency
contact: _________________________
Emergency
phone: _________________________
Registering
for (please circle):
Session
1 full-day ($325) Session
1 half-day ($215)
Session
2 full-day ($325) Session
2 half-day ($215)
Session
3 full-day ($325) Session
3 half-day ($215)
Session
4 full-day ($325) Session
4 half-day ($215)
Session
5 full-day ($325) Session
5 half-day ($215))
Session
6 full-day ($325) Session
6 half-day ($215)
Session
7 full-day ($325) Session
7 half-day ($215)
Session
8 full-day ($325) Session
8 half-day ($215)
Session
9 full-day ($325) Session
9 half-day ($215)
Either
drop off or mail registration
to:
EBRC
225
Highway 18 South
East
Brunswick, NJ 08816
All
checks payable to EBRC |