Private Team Camps Registration - Purler Wrestling Inc.

Coach's/Coordinator's Name*

First Last

Email*

Enter Email Confirm Email

Camp Location Name

Camp Location Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Work Phone

Starting date of your workshop*

Length of Workshop*

Which camp system would you like us to teach?*

Phase I
Phase II
Phase I & II (3 day or 5 day only)

Name of hotel you have reserved for you (leave blank if unknown)

Needed for the night before the camp and the second to last day...we will fly out on the final day. PS - ALL hotels require you to pre-pay at the counter in person and reserving a room over the phone does not guarantee the room for us.

Hotel Phone Number

Nearest Airport*

Is this a workshop for your team only, or is it open to outsiders?*

Who will be paying for the kids attending the camp?*

By typing my name below, I agree to the workshop for the set date. Remaining balance is due on the last day of camp.*

Camp Deposit Fee*

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name