Leadership and Identity Development Summer 2000
August 20-23


Participant's Name

Sex Male Female
First Time Attendee? Yes No Age
Mailing Address Date of Birth
City State
Phone Zip Code
Email address
Primary Language
Secondary Language
Age Group Junior High (7th-8th)
High School (9th-12th)
College 		T-Shirt Size S
M
L
XL
Allergies/Medical/Special Dietary Needs
Costs:
$190 before July 28
$200 after July 28
$170 Partial Camp (please include dates)

Please check the above information for accuracy. If all entries are correct, print this page now for your own records. Additionally, you should fax a copy to (626) 463-1269 x5803 for verification purposes. Payment for camp must be received within 7 days upon completion of this form. Click on Submit to continue.


Make checks payable to Taiwanese American Citizens League
TACL is a nonprofit organization. All donations are tax deductible
CANCELLATIONS ARE SUBJECT TO A $100 PENALTY