Qigong Southwest - Zhixing Wang Booking Form

Your name*

Others' names, with age if child

Email Address*

Postal Address*

Postcode*

Telephone*

Deposits (non-refundable)
Adults @ £40 Children @ £20

Total deposit amount

Would you be able to distribute some leaflets?
Yes No

If so, how many?

Are you able to offer a lift? Do you need a lift?

How did you hear of the camp?

Any special needs/requests?

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Action: (Please note you will have to send your deposit
in the form of a cheque - address below.)

As our events are very popular and the numbers are limited please book early to be sure of a place by sending your (non-refundable) deposit, payable to Z.Wang, to the address below.

Qigong Southwest
46 Glebelands

Buckfastleigh

Devon TQ11 0BJ

Tel: 0845 3305086 | E-mail:

A map and details of what to bring will be sent on receipt of the deposit(s).