Registration Fall Offerings 2017 Please use this form to sign up for scheduled retreats and workshops. Use the TAB key to move through the form. Use of the ENTER key may cause your form to be submitted prematurely. If the retreat or workshop is filled, we will contact you to add your name to our waiting list and let you know if an opening occurs. _____________________________________________________________________ First Name (required) Last Name (required) Email (required) Phone (required) Address Line 1 Address Line 2 City, State ZIP ______________________________________________________________________ Please complete this section if pertinent and/or different from above. Company/Organization Work Phone Business Address Line 1 Business Address Line 2 City, State ZIP _______________________________________________________________________ Register for a scheduled retreat or workshop Choose from this menuQuiet Day $20Wednesday Wisdom Circle $125Thursday Wisdom Circle $125Introduction to Zentangle $40The Space Between $40Sepia $40Book Study $135 or 250/coupleMindfulness $40 _____________________________________________________________________ Would you like a Healing Ground brochure? YESNO Please send your payment to the address below when you register. We will work with you if you need to pay in installments. To inquire about other bookings, CONTACT US.