reg.form

Please print the page below or download Word doc. here

REGISTRATION FORM

for
JOURNEYING TO THE INNER TEMPLE
Rose Baudin
JUNE 18 - 24 2005

* Please contact Alison below to ensure there is a place available for you before sending completed form and payment.

Please PRINT or TYPE all information.

Full Name
Postal Address


Daytime Phone Number
Mobile/Cell Phone Number
Email Address
Would you like to be included on our email mailing list?
Costs:	Single $1,500US	Twin Share $1,300US

Payments:
Your place is secured with a $500US deposit. There will be 20% deducted for cancellations more than 30 days before the retreat commences. The deposit is completely non-refundable less than 30 days before the retreat commences. This deposit will go towards your total payment. The balance is due at least 30 days before the retreat commences.

Cheque _______________( Amount Enclosed)

Please make cheque payable to" Vitality4Life"

Credit Card Payment

Type of Card

Full Name on Card

Credit Card Number

Expiry Date

contact

apearl@mullum.com.au

Alison Pearl

61 2 66 845 570

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