China-Tibet Trip Registration Form
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Qigong China Trips
PO Box 750
Ely, MN 55731 USA
phone: 218-365-6330
fax: 218-365-6933
Today's Date______________
Name_____________________________________
Address___________________________________
Gender______
City______________________________________
State___________________
Country___________________
Postal Code /Zip Code_______________________
Phone Number______________________________
E-Mail Address______________________________
Trip Date Please Circle One of These Dates (women's sacred journey May 2008) ( Shangri-La June 2009) (Oct.2008) (Solar Eclipse July 2009)
Shared Room ( ) or Single Room - when available $450.00 additional ( )
Name of preferred room mate - if applicable ____________________
I am interested in registering for the study program at the Sichuan Culinary Institute. Yes ( ) No ( ) If the culinary classes are offered in the itinerary of the trip you have chosen. There is an additional fee for this option.
Please list any Allergies_______________________________________________________________
Please tell us of any Health Issues which could limit your participation in the trip_______________________________________________
Trip Fees please circle one one the next line below
(May 08, $3,950.00 or $3833.00 w/cash discount) (June 08, $3,337 w/cash discount $3689.00) (Oct 08, $3545.00 or $3466.00 w/cash discount)
Deposit Fee $800.00
Payment Type Enclosed:
Check ( ) Money Order ( ) Master Card ( ) Visa ( )
Please make checks payable to: Dao-Of-Well-Being/China Trip
For Master Card or Visa payments:
Name as it appears on your card _______________________________
Credit Card number: _________________________________________ Expiration date: ___________ CVS#______(3 digits on card back)
Credit card billing address:______________________________________________________________
Signature: ____________________________________
Please mail your reservation and deposit to:
Dao of Well-Being™
PO Box 750
Ely, MN 55731