Registration Form
Name _____________________________________________ Date ________________
Rank __________________ Instructor _______________________________________
Emergency contact _______________________________________________________
Special meal requested [ ] Vegetarian [ ] Vegan
Camp fee $100 (includes camp t-shirt) Size: ___S___M___L___XL___XXL
Paid by (please circle one): check cash
Make checks payable to Mo Duk Pai Association. Give to your instructor on or before May 13