Kenpo Super Camp (3 Days)
Attend 1 or all days
Registration Form
Open to all ranks -- all styles

3 Days:  July 21, 22, 23 2006 - Fri-Sat-Sun 
2558 Palumbo Dr
Lexington KY - 859-271-5987
Fax - 859-223-9175
e-mail -- patkenpo@aol.com
(State "Kenpo Camp" in subject line)

Cost: any 1 day $75 - any 2 days $100 - all 3 days $125
add $25 for all additional family members
(Bonus: if you Register and Pre-pay - you will get a free DVD!
Any DVD I offer - your choice!!
Mail To: Tracys Kenpo
PO. Box 24060
Lexington, KY 40524-4060

        Name ______________________________________________ Age __________

        Style ______________ Rank ___________ Instructor _______________________

        Address - Street _____________________________________________________

        City _______________________________ State ____________ Zip ___________

        Phone ______________________ e-mail _________________________________

        Enclosed  Check __________

        Charge my credit card - NO. _________________________ Exp Date ___________

        Phone - Mail - Fax or e-mail

If more than one attending
List Below

     1. Name _______________________________________ Age_________

       2. Name ______________________________________ Age__________

      3. Name _______________________________________ Age_________

       4. Name _____________________________________________ Age________