YLC2 adult staff enrollment updated 7-27-15
Klemmer & Associates
The Premier Leadership & Character Development Company
Youth Leadership Camp 2.0 Adult Staff
Youth Leadership Camp 2.0 will be held on:
July 24th – July 31st, 2016
For more information contact:
Kari Ramon
Ph: 801-554-8757
Email: kari@klemmer.com
at Ponderosa Retreat & Conference Center in Larkspur, CO
Name:____________________________________________________
Address:_____________________________________________________________________________________
City:________________________________________________ State:_____________ Zip:__________________
Home Phone:_________________________________ Work Phone:_____________________________________
Cell Phone:___________________________________ Fax:____________________________________________
Email:____________________________________________________________ Date of Birth:_______________
Adult Staff Tuition: $1250.00 US Dollars, of which $200.00 is non-refundable/non-transferable
(Tuition includes: meals, lodging, photos, and transportation to and from the designated airport)
My signature below authorizes the background check and acknowledges that I understand and agree that
$200.00 of the tuition is non-refundable/non-transferable
Signature:________________________________________________________Date:______________________
Should you choose to submit this form electronically, typing your name on the line above acknowledges the terms of this agreement and
constitutes your electronic signature. Any photocopy, facsimile, electronic or other copies of this agreement shall have the same effect for all
purposes as an original.
Payment Information:
□ Cash □ Check, Payable to K&A □ Money Order □ Visa □ MasterCard □ Discover □ Amex
Card Number:______________________________________ Expiration Date:___________ V Code:___________
Amount:____________________ Name on Card:____________________________________________________
Billing Address (if different from home):___________________________________________ Zip: ____________
Klemmer & Associates Inc.
1340 Commerce St., Suite G, Petaluma, CA 94954 Ph: 800-577-5447 – Fax: 707-762-1685
www.klemmer.com
YLC2 adult staff enrollment updated 7-27-15
Klemmer & Associates
The Premier Leadership & Character Development Company
Youth Leadership Camp 2.0 Adult Staff
Youth Leadership Camp 2.0 will be held on:
July 24th – July 31st, 2016
For more information contact:
Kari Ramon
Ph: 801-554-8757
Email: kari@klemmer.com
at Ponderosa Retreat & Conference Center in Larkspur, CO
Congratulations on choosing to staff the Youth Leadership Camp 2. A deposit will not guarantee
that a seat will be held for you, payment in full is the only way to guarantee your placement in the
training. $200.00 US of the total tuition price in non-refundable and non-transferable and will be
retained on all tuition agreements received regardless of attendance at the Youth Leadership Camp.
Once you have begun the training, no portion of the tuition amount is refundable. Any and all
payments on the Youth Leadership Camp 2 can be rolled forward to the next class should an
immediate class not be available to you
Adult Staff Tuition: $1250.00 US Dollars, of which $200.00 is non-refundable/non-transferable
(Tuition includes: meals, lodging, photos, and transportation to and from the designated airport)
My signature below authorizes the background check and acknowledges that I understand and agree that
$200.00 of the tuition is non-refundable/non-transferable
Signature:________________________________________________________Date:______________________
Should you choose to submit this form electronically, typing your name on the line above acknowledges the terms of this agreement and
constitutes your electronic signature. Any photocopy, facsimile, electronic or other copies of this agreement shall have the same effect for all
purposes as an original.
Payment Information:
□ Cash □ Check, Payable to K&A □ Money Order □ Visa □ MasterCard □ Discover □ Amex
Card Number:______________________________________ Expiration Date:___________ V Code:___________
Amount:____________________ Name on Card:____________________________________________________
Billing Address (if different from home):___________________________________________ Zip: ____________
Klemmer & Associates Inc.
1340 Commerce St., Suite G, Petaluma, CA 94954 Ph: 800-577-5447 – Fax: 707-762-1685
www.klemmer.com