Summer Camp '04 registration form

[Note -- If your computer won't allow you to use this custom form, click here to send a regular e-mail message to Sensei Melaugh with all the information. Otherwise, use the form below.]

Please complete each item, then press the "SEND" bar. Press only once.

First name   Last name

E-mail address   Street:

Town/city:  State/province:

 Zip/postal code:   Country:

Where and with whom do you train:

Your rank:

I am registering for:

    Three-day training and recreation package June 11, 12 and 13 at Lake Winnipesaukee.
    This includes boarding and meals. Cost of tuition and boarding is $295. No at-the-door registrations will be accepted.

    Non-training guest package. Guests have full access to recreational activities and are lodged with their registered friends in shared cabins on the beachfront. Guests get everything except the insruction for only $175 for all three days.

    One-day classes, workshops and recreation. This does not incluide boarding. Lunch or dinner available. See Ed for details.

    Friday. $100.

    Saturday. $120.

    Sunday. $100.


To pay by mail or at the school, print this completed form and bring or mail it with your check, money order or Visa/Master Card details to:

    Ed Melaugh's Summer Camp
    Small Circle Jujitsu
    2 Merrill St.
    Woburn MA 01890

I authorize total payment of   $ from the credit card noted below.

Master Card #   Visa #   Expiration Date