ManKind Project Upstate New Your Weekend Training Enrollment Form

Please enroll me in the New Warrior Training Adventure at the Upstate New York Center for the weekend of ___May 19-21, 2006

Enclosed is my ___ $150 US (non-refundable) deposit
or ___ $650 US full tuition payment ($150 non-refundable).

Name____________________________________________________________________

Address_________________________________________________________________

City_____________________________________ State _____ Zip ____________

Home Phone (_____) _______________ Work Phone (_____) _________________

Fax # (_____) _________________ E-Mail Address _____________________

___ Visa/ __ Mastercard #_____________________________ Expires _________

Name as it appears on Card _____________________________________________

Signature for Credit Card ______________________________________________

Other Pertinent Information ____________________________________________

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