Date of Retreat: Aug 22-24, 2008 Oct 10-12, 2008

Surname Name: First Name:

Address:

City:

Prov:

Country: Zip/Postal Code:

Telephone: (please include area and country code)

Cell Phone:

Work Phone:

Email:

Food Allergies:

How did you hear about this workshop?

Please specify DOUBLE OCCUPANCY ($1099) OR SINGLE OCCUPANCY ($1199)

Please note that assignment of rooms is on a first come, first serve basis. A deposit of $250 per person must be received to guarantee your reservation, as space is limited.

How will you be paying your deposit?

Paypal - (a secure online payment system that takes creditcards and debit)

Cheque - (mailing instructions on next page)