GREGOR GRACIE

12/1/2016 6-8PM

**REGISTRATION IS OPEN!**


How did you hear about the seminar?:

First Name
Last Name
Date of Birth
Email (required)
Phone # (required)

Street
City
State (abbreviation; PA, NY, OH, etc.)
Zip Code
Gym/Instructor’s Name

Current-CPAMMA Student / Non Student: (required)

FIRST 15 PEOPLE:
$25 (CPAMMA Students Only)
$50 (Non-CPAMMA Students)

NEXT 15 PEOPLE:
$35 (CPAMMA Students Only)
$60 (Non-CPAMMA Students)

NEXT 15 PEOPLE:
$50 (CPAMMA Students)
$75 (Non-CPAMMA Students)

NEXT 20 PEOPLE / After November 30th:
$75 both current and non-CPAMMA Students

**NO Refunds unless Seminar is Canceled**

Additional Comments:


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