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MAKE CHECKS PAYABLE TO:  MARILYN ALLYSUM

Mail to: 

Tilopa Tai Chi Qigong Center

since 1977

PO Box  300103

www.iTaiChi.com

Minneapolis,  Minnesota 55403

612-825-6824

Name: __________________________________________________

Address: ________________________________________________
City: _____________________________  State: _________  ZIP: __________

Home Phone: __________________    Work Phone: _____________________
Email: _______________________________  Cell: _____________________

ENTER THE APPROPRIATE CLASS TUITION PAYMENT BELOW:

GRAND LONG FORM TAI CHI CHUAN & QIGONG, Level 1 Beginner:
          Thursday Evenings,  6:00 - 7:30 PM                
          Payment Enclosed:   $ _______ Quarter 1 (DVD sold separately)

LONGEVITY  TAI CHI  &  QIGONG, Beginner Level:
   (Check Saturday or Tuesday.)
  ____ Saturday Mornings,  8:45 - 10:00 AM              
  ____ Tuesday Mornings,   8:45 - 10:00 AM              
          Payment Enclosed:   $ _______ (DVD included)

Temple Qigong:
           Saturday Mornings,  10:30 - 11:30 AM            
          Payment Enclosed:   $  _____

OUTREACH PROGRAMS:
Site Location: _______________________

Date of Class: _______________________    Payment Enclosed: $________

Classes are not pro-rated. No Refunds.
Locations:
Monday, Thursday, & Saturday classes:
Tilopa Tai Chi Qigong Center
Lynnhurst Church
4501 Colfax Av. S, Minneapolis, Minnesota
Enter on Colfax Av (South Wing)		 Tuesday Morning class:
 Minikahda Club
3205 Excelsior Blvd.
Minneapolis, Minnesota

How did you hear of us? ___________________________________________________