ANNUAL INTENSIVE TRAINING SERAK® CAMP REGISTRATION FORM

Registration: Received on or before August 25, 2005, Camp fee will be $250; if received after August 25, but on or before September 22; Camp fee will be $300.
CAMP IS FULL AND IS NOW CLOSED!!!!

NO PERSONAL CHECKS WILL BE ACCEPTED, NO Exceptions.
Please pay by Credit Card, Money Order, or Cash-In Person only.

For payment by credit card, please fill out the following:

Please print your name and street address clearly:

BILLING ADDRESS:                                     DATE:_________________

NAME _____________________________________________________
ADDRESS __________________________________________________
CITY ________________________ STATE _______ ZIP _____________
PHONE(s) ____________________________________________________
EMAIL ADDRESS: ___________________________________________

Please print this form and either Fax or mail (with payment) to:
VDT Academy
P.O. Box 1663
Bellflower, CA 90707-1663
FAX #: (562) 920-1827

CLICK HERE TO GO BACK TO CAMP INFORMATION PAGE

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