Sacred Self
Events & Retreats
Contact Us
Surf Club Registration Form
Participant Name
*
First
Last
Date of Birth
*
School
*
Phone Number
*
Height and Weight (for equipment/wetsuit sizing)
*
Surf Experience
*
Parents Name(s)
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone Number
*
Which Session Will Your Teen Attend?
*
Beginning June 21st
Beginning June 28th
Program Cost
*
Price:
$1,200.00
Complete registration and pay
When you click submit, you will be redirected to PayPal to complete your payment.
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Sacred Self
Events & Retreats
Contact Us