Date of Retreat: August 1-3, 2008

First Name:: Surname:

Address:

City:

Prov:

Country: Zip/Postal Code:

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Please indicate second address below (include all detail as above):

Cell Phone:

Email:

How did you hear about this workshop?

A deposit of $250 per person is requied to guarantee your reservation, as space at this retreat 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)