Ki Sui An 
Shakuhachi Camp
Temenos
Retreat Center
West Chester, PA

Name

Street Address

or   P.O. Box

City

State

or   Province

Postal Code

Country

Phone

Alternate Phone

Fax

email

Attendance
(uncheck any days
you will not be
attending)

29th
30th
31st
1st

Accommodation

Single Room Double Room Commuter - choose -

I will be rooming with (optional)

female
male

Playing level

Meal choice

Comments

Cancellation Policy

We will give 100% refunds for cancellations received prior to August 10th, 2008. We will give 50% refunds for cancellations received from the 10th - 20th. No refunds after 20th (except for a medical emergency).

Payment Method (Please choose one)

I will mail a check for the tuition fee ($395)
     plus room charges (see camp prices).  
     Checks are made out and mailed to: 

          Ronnie Nyogetsu Seldin
          185 West Houston Street, Apt. 2K
          New York, NY  10014

I will pay using PayPal online payment service.  
    You can use your existing PayPalaccount if you have one, 
     or you can create a new PayPalaccount (setup is free).  
     This option will allow you to pay by credit card or by 
     electronic check once your PayPalaccount is activated.