Registration Form - Relationship Renewal Couples Weekend Retreat

Date of Retreat: May 16-18, 2008 June 27-29, 2008

Her Name:

His Name:

Please check if address is for both of you:

Address:

City:

Prov:

Country: Zip/Postal Code:

Telephone: (please include area and country code)

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

Her Cell Phone: His Cell Phone:

Her Work Phone: His Work Phone:

Her Email: His Email:

We will make your hotel reservations, please indicate if you would like Queen or King size bed?

Queen Size Bed         King Size Bed

How did you hear about this workshop?

A deposit of $400 per Couple ($200/each) 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)