REGISTRATION FORM

(Print out this page or Brochure)
Please make checks payable to Fode Bangoura,
and mail this form with your payments to:

Fodé Bangoura
3951 Pleasant Ave. South
Minneapolis, MN 55409

$500 Deposit due at registration

Balance due by November 1, 2011
____2 weeks ($500 balance)
____3 weeks ($1000 balance)
____4 weeks ($1500 balance)
above prices do not include deposit

____Early Bird Special 4 weeks $1600
paid in full by September 15, 2011

Cancellation fee $500 after Nov 1, 2011
No refund for cancellations made after Nov 30, 2011

YOUR NAME:___________________________________________

Address:_______________________________________________

_______________________________________________________

email:

Cell phone:_____________________________________________

Other phones:___________________________________________

EMERGENCY CONTACT :_________________________________

Address:_______________________________________________

_______________________________________________________

email:

Cell phone:______________________________________________

Other phones:___________________________________________

Allergies, dietary needs
and/or Medical Concerns:_________________________________

_______________________________________________________