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Registration Application Ki Gong South Clinic - Austin, Texas Sponsored
by Mindful Movements of Ki Gong April 8, 2017 8:30am to 3:30pm |
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Name
_________________________________________________________________________________
Address _______________________________________________________________________________
City _________________ State ____________
Zip ____________ Country _________________________
Phone ______________________ E-mail ___________________________________________________
Light lunch will be provided. Water will be available.
Feel free to bring your own lunch items.
Any special needs? Please explain: ___________________________________________________
****We prefer you to wear the official
World Ki Gong Club uniform while participating in the Clinic.
In order to place the request, all
Uniform request must be paid for by the Mar 17, 2017 deadline.
If application submitted after Mar 17,
2017 plan to wear a plain white shirt and black pants.
Are you a World Ki Gong Club Member? _____ Yes. www.worldkigong.com
If you would like
to join World Ki Gong Club, applications will be available at the Austin
clinic.
ENTRY FEES AND DEADLINES
Application Submitted by: 3/17/2017 until 4/3/2017 (final)
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Ki Gong Clinic |
$65 |
$75 |
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Ki Gong Shirt ** |
$15 |
n/a |
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Ki Gong Pants ** |
$15 |
n/a |
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** T-shirts/pants cannot be ordered after the 1st
deadline |
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T-shirt Adult Sizes (S M
L XL XXL) Rank Color_________ White (I,II) Yellow (III), Blue (IV, V), Red (VI)
Pants Size (1 2 3
4 5 6)
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Total Amount Due $
__________
Make
check payable to: Ek Creations Studio
13466 Gent Drive
Austin, Texas 78729
Hotel accommodations at “Ki Gong
South” rates available till Mar 17 for $112 King, $122 Queens
Call Fairfield Inn & Suites, 13087
US HWY 183 N, Austin TX, 78750 Phone: 512-258-410
I understand all requirements of my clinic participation and
agree to abide by all rules. By
registering for this clinic
I understand that the practice of Ki Gong requires time,
patience and hard work. I expect to learn healthy application
of time tested principles and do not expect diagnosis or
cure of any disease process. I assume
all risk. I hold
harmless all instructors, agents, principles or members of
the World Ki Gong Club and the WTSDA.
Signature ________________________________________ Date _____________