ELKHORN FITNESS RETREAT

FOR POSSIBLE FITNESS RETREAT DATES IN 2004 PLEASE CONTACT JIM AND BOBBI POMROY

REGISTRATION FORM

NAME_______________________________________________________________________

ADDRESS____________________________________________________________________

PHONE___________________________________

ANY CURRENT MEDICAL PROBLEMS? (Please describe) _________________________________________________________________________________________________________

ARE YOU ON ANY MEDICATIONS? (Please describe) _____________________________________________________________________________________________________________

IF YOU HAVE ANY MEDICAL PROBLEMS, PLEASE HAVE A DOCTOR'S CHECKUP AND PRESENT A COPY OF THE THE WRITTEN DOCTOR'S RELEASE TO THE FITNESS RETREAT ORGANIZERS BEFORE PARTICIPATING IN THE ELKHORN FITNESS RETREAT EXERCISE PROGRAM.

I AM REGISTERING FOR PARTICIPATION IN THE FOLLOWING WEEK LONG PROGRAM (S):

FOR POSSIBLE FITNESS RETREAT DATES IN 2004 PLEASE CONTACT JIM AND BOBBI POMROY

Please submit one-half of the registration fee with entry and the final payment upon arrival. Make checks payable to Elkhorn Fitness Retreat, 597 McClellan Creek Road, Clancy, Montana 59634.

Questions-phone: 406-439-3106 or e-mail- pomroy@montana.com