Workshop Registration Form — The Rochester T'ai Chi Ch'uan Center

Fill out the REGISTRATION FORM and submit. When you submit your place will be guaranteed.

Please read the following information before signing:

Use one form per person.
Please include home and/or cell phone number along with an email address.
RTCCC reserves the right to cancel a scheduled workshop with notice or due to unforeseen circumstances.
If a workshop is cancelled or filled, the registration fee will be refunded or credited toward a future workshop at your request.

You can pay by mailing Registration Form with a check, or bring payment with you the day of the event.

THE ROCHESTER T'AI CHI CH'UAN CENTER
595 BLOSSOM RD
SUITE 309
ROCHESTER, NY 14610

Workshop Registration

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Home

(###)

###

####

Phone Work

(###)

###

####

Phone Cell

(###)

###

####

Specify Workshop

Waiver Liability waiver: I agree to waive claims against any person(s) and the faculty connected with class(es) or special event(s) for injuries that I might sustain, and I assume full responsibility for all my actions in connection with said class(es) and event(s.) For insurance purposes, anyone not currently an RTCCC student, and who is attending a workshop at the Rochester T’ai Chi Ch’uan Center needs to become a short-term enrollee of the center for the duration of the workshop. There is no charge for this. All that is needed is a signature below which indicates your enrollment and your acceptance of the student liability waiver included on this brochure. I have read the included liability material and accept the conditions therein; I am enrolling short term for the duration of the workshop:

Workshop Registration

595 Blossom Rd. Suite 309 Rochester, NY

Copyright Rochester T’ai Chi Ch’uan Center 2023