(If at all possible, please send in your registration by the end of April.)
Phone No: ________________________________________________________
E-Mail Address: ___________________________________________________
FOOD PREFERENCES [Meals will be vegetarian, some with fish]
Special dietary requirements:
ROOM PREFERENCE [check]
occupancy (3 persons) [
] $ 395
Doubles occupancy (2 persons) [ ] $ 480
Single occupancy (1 person) [ ] $ 550
Roommate(s) request: _________________________________________
THE FEES cover your room and board and contribute toward the expenses of our teachers’
room and board.
Unless already sent in, a $200 DEPOSIT should accompany this form.
The balance will be collected at the Retreat.
Make check payable to Bob Segbarth and send to him with this registration form:
211 West Floresta Way,
Valley, CA 94028
We do not want financial concerns to limit participation. If you wish to make a tax-deductible contribution, please include with your registration to Bob Segbarth a separate check made out to
Circle of Joy.”
Ardella Nathanael: (415) 499-8027
Bob Segbarth: firstname.lastname@example.org
It would help our administrative arrangements if you would send this in AS SOON AS POSSIBLE.