Registration and Payment

Your Name (required)

Your Email (required)

Team Name (required)

Organization

Street Address

Street Address Line 2

City

State Zip

Phone

Website

Additional Player #1:  Please provide the following contact information:
Name

Email

Phone

Additional Player #2: Please provide the following contact information:
Name

Email

Phone

Additional Player #3: Please provide the following contact information:
Name

Email

Phone

 I don't have a team; please assign me to one

 I Have Read the Terms and Conditions

You may also download and print the form:  Registration Form and mail it to:

PathSeeker Center
Attn: Giselle Washburn
4905 Van Dyke Rd., Suite 14
Lutz, FL  33549

 
PAYMENT:

The player fee is $85 per person (this includes dinner).
You may conveniently pay by check, by credit card over the phone or through Paypal.

To pay by phone, please call Giselle Washburn at 813-732-4177.
Online playments are made below through Paypal
(a $2.50 service charge per player is added for paying by credit card)

Number Registered
Team Name:

   
Make all checks payable to: PathSeeker Center

 

 Mail to:

PathSeeker Center
Attn: Giselle Washburn
4905 Van Dyke Rd., Ste 14
Lutz, FL 33558

 

 

 

 

Thank you for registering!