|
Registration Form
|
| NAME ____________________________________________________________________ |
| ADDRESS ________________________________________________________________ |
| CITY _____________________________________________________________________ |
| POSTAL CODE _______________ |
| TELEPHONE
______________ |
| home
_______________________ |
| cell _________________________ |
| work________________________ |
| WORKSHOP
or RETREAT YOU ARE REGISTERING FOR
_______________________ |
| ________________________________________________________________________________________ |
| METHOD OF
PAYMENT VISA , MASTER CARD , AMEX , CHECK PLEASE CIRCLE
ONE |
| CARD # _____________________________________________
EXPIRY DATE __________ |
| SIGNATURE
________________________________________ |
| AMOUNT
______________ |