2010 Summer Budo Camp Registration

July 30th - August 1, 2010

Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Age (as of camp) *
Dojo *
Empty Hand Rank and Date of Promotion *
Name of Chaperone (if under age 19) First Last
Room Preference (includes $25.00 LATE FEE after 06/20/2010) *

If we cannot accommodate your request for a quad or triple, we may have to upgrade your room to a double and charge you accordingly. Additional charges will be settled at camp. Payment information will be collected on next page.
Name(s) of people you wish to share room with:

We will try to accommodate your preference for roommates, but we reserve the right to make final room assignments
Dietary Needs

If you have any special dietary requirements, including foods you cannot eat you must specify now or you will be served the planned selections. Liberty Mountain cannot make last minute dietary changes.
Want A T-Shirt (extra charge - pay at camp) Yes Please No Thanks
Reserve a 2010 Summer Budo Camp T-Shirt. Payment will be collected at camp.
T-Shirt Size
To complete your registration select "Continue" below. You will be given a chance to review your registration information and then taken to the payment page.