THIS IS NOT AN ONLINE REGISTRATION FORM - FOR PRINT ONLY            Printed Date: 3/31/2020 11:17:41 AM

Seminar Title:
Tai Chi for Fall Prevention Retreat & Instructor Certification
Seminar Date:
Wednesday, September 16, 2020
Seminar Location:
BOONE, NC 28607
Seminar ID:
81421

  Required (select one)
 
EARLY BIRD REGISTRATIONS AVAILABLE THROUGH JULY 16, 2020


Before July 16, 2020
    $2,199.00 Registration: HOTEL Style - Single Occupancy
    $1,999.00 Registration: HOTEL Style - Double Occupancy
    $1,799.00 Registration: RETREAT Style - Single Occupancy
    $1,599.00 Registration: RETREAT Style - Double Occupancy

After July 16, 2020
    $2,399.00 Registration: HOTEL Style - Single Occupancy
    $2,199.00 Registration: HOTEL Style - Double Occupancy
    $1,999.00 Registration: RETREAT Style - Single Occupancy
    $1,799.00 Registration: RETREAT Style - Double Occupancy


  ________ HI, NM attendees add applicable sales and local taxes**
  ________ Subtotal (Required items + sales tax)
   
  ________ Total (Required subtotal + Optional subtotal)
  *** Registration for coordinator or military member discount must be completed online
  **** All prices are shown in US Dollars ****
 
 

Please enter the MAIL CODE in the box below.

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back in the box above the address block.

If you do not have a brochure, please enter 888.

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First Name:
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Profession:
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  Note: Leave Company/Department blank if providing home address
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(required for confirmation of registration)

  Prepayment is REQUIRED
  Check enclosed
  Signed Purchase Order enclosed
Credit Card Type:
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Credit Card #:
  V-Code #*
Exp Date:
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*American Express: 4-digit # above account # on face of card
Name on Card:
Mail or Fax to:
PESI Rehab, P.O. Box 1000, Eau Claire, WI 54702-1000      (800) 554-9775 (fax number)