:::INNER RHYTHM SURF CAMP:::On-Line Registration

INNER RHYTHM DAY LESSON REGISTRATION FORM

Applications can be submitted:
By phone: 250-726-3456 or 1-877-393-SURF
On-line Fill in this secure registration form.
Mail: Inner Rhythm Surf Camp, Box 421, Ucluelet B.C., V0R 3A0

Payments can be made using cash, Visa, M/C or certified cheque.

When the application has been processed, you will receive a telephone call confirming your booking and once deposit has been received we send out a confirmation letter, an information package, recipt and any other info requested at time of booking. .

If you do not receive this letter within two weeks of registration please call our office at 1-877-393 SURF

Today's Date
Name
Male Female
E-mail Address
Address
City
P/C
Home Phone
Work Phone

Lesson Details:

Lesson Date
Lesson Time:	10am 2pm
Number of people:

Please list each participant's name and wetsuit details:

Name
Height
Weight
Shoe

Name
Height
Weight
Shoe

Name
Height
Weight
Shoe

Name
Height
Weight
Shoe

Name
Height
Weight
Shoe

Payment Information

Name on Card:
Credit Card Number:
Exp. date: MM: YY:	Card Type:

Payment is required to hold reservation. There is a 48 hour cancellation policy in effect. Anything less than 48 hours notice is non-refundable.

Must be 18 years or older to sign a waiver. All waivers must be signed before any services commence with Inner Rhythm.
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Your information is never shared and is kept secure using 128bit SSL and an additional AES algorithm with a 128-bit key. It protects this key using the RSA Public Key algorithm with a 2304-bit modulus.