Space Coast Surf Camp

2010

Please use one form per participant

Participants Name:                                                                                    

Parent’s Name:                                                                                    

Street Address:                                                                                 

City:                                State:                       Zip Code                       

Sex: M / F                       Age:                                                           

Telephone:                       E-Mail:                                                 

Please circle desired week of camp attendance.

   Camp 1-6/7-10

   Camp 2-6/15-18

   Camp 3-6/21-24

   Camp 4-7/6-9

   Camp 5-7/12-15

   Camp 6-7/19-22

   Camp 7-7/26-29<><                  

   Daily rate $50

Surfing Experience:  Extensive / Moderate / Some / None

Youth T-Shirt Size: Small / Medium / Large / XL

Adult T-Shirt Size:  Small / Medium / Large / XL

*Each participant will receive a wooden surfboard certification plaque.

 Checks payable to George Robinson

Payment Method:  Cash or              Check amount enclosed:  

PAYPAL Available Upon request :e-mail us
george@grdesigns.com                     

 Questions call 321-698-6169

Mail Fees and registration to:          George Robinson

                                                P.O. Box 360724

                                                Melbourne, FL 32936