POTENTIAL to PERFORM
ONLINE REGISTRATION FORM
Last Name *
First Name *
Phone Number *
EMail Address *
(will be preferred mode of communication)
Locality (Town/Village) *
Age *
Male/Female: *
If under 18 yrs of age, please provide name and mobile number of Responsible Party:
Day 1 Travel Preference: *
The programme on Saturday 24th August involves a trek along the South Coast and the meeting point will be L'Escalier. Please indicate your option here for arrangements to made on our side.
Stay Overnight Option: *
The Camp is Non-Residential but there are limited options (on a first-come first-served basis) for staying over at our Beau-Bassin Ashram on Saturday 24th August night. Would you like to stay overnight?
Any specific remarks?
Please briefly enter any specific points you may wish us to take note.
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