Fight Club Boot Camp Registration

Fight Club Boot Camp 31 May - 3 June 2012
Camp Fee $305.00 - Registrations Close 10th May 2012
This event requires a $100 non refundable deposit at time of registration to secure your place.

Payment options will be given after this form is submitted.
Options include Paypal (Credit Card or Account), Cheque or Direct Deposit.

Attendee Information (*Denotes Required Field)
Title: *
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Given Name: *
Please supply your given name.
Surname: *
Please supply your surname.
Address: *
Please enter your street address.
Suburb/Town: *
Please supply a suburb or town.
State: *
Please supply your state name.
Postcode: *
Please supply your postcode.
Country:
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Email Address: *
Please enter a valid email address.
Contact Phone No: *
Please supply us with a contact phone number.
Age: *
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Your Church Name: *
Please supply us the name of the church you attend.
Any medical conditions/allergies we should be aware of:
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Special Dietary Requirements:
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Additional Comments:
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Do you wish to join in Laser Skirmish? *
Please indictae if you wish to join in on Laser Skirmish
A $100 non refundable deposit at time of registration is required to secure your place. Balance is payable by 10th May 2012
DISCLAMER: Prices are per person unless otherwise stated. Please note that all bookings are subject to availability at time of receipt. Life House Conference recommends that you confirm your registration with our office prior to booking any flights/accommodation to attend conference. The Life House Conference does not accept any responsibility for any losses incurred, including but not limited to, flights and/or accommodation booked for the conference.


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