October 11-15, 2017
(please print clearly!)
(please make sure your email
is written clearly, otherwise you will not receive emails about the retreat.
**I understand there are absolutely no refunds of the registration fee, that the fee is non-transferable, and that I agree to these terms by signing below. Failure to sign will void the registration.
Payment is due in full when application is mailed.
Registration will be limited to 100 attendees.
We accept check, money order, **Visa, Mastercard, AmExp, Discover and PayPal for registration payment. **There is an additional $3.00 processing fee added when paying by Credit Card or PayPal.
Circle one - Visa - MC - AmExp - Discover + **$3.00
CC#________________________________________ Exp. date____________ 3 digit code on back of card _________
Signature to allow your card to be charged: _______________________________________________
Please include billing address if different from above: