Summer 2012 Training Camp with Stellan Bengtsson

Registration Form
From Thursday, August 30 through Monday, September 3, 2012
At the Willamette Table Tennis Club (www.wtabletennis.org)
1960 Oak St. SE, Salem, Oregon

Capacity is limited and prepayment is required.
Fee: $500
Questions? Contact Ben Bednarz at
xxxxxxxcell: 503-851-2941
xxxxxxxemail: president@wtabletennis.org
Make your $500 check payable to:
xxxxWillamette Table Tennis Club
and mail to:
xxxxxxxc/o Ben Bednarz
xxxxxxx780 Commercial St. SE
xxxxxxxSuite 300
xxxxxxxSalem, OR 97301
Name:
Rating:
Age if Junior:
Home Phone:
Cell Phone:
Email:
Address:
Questions/
Comments:
   
    
Special discount for those over 1900
First time participants only: rated over 1900, take off $50
from your fee. Total price is only $450.