(If
at all possible, please send in your registration by the end of April.)
Name: ___________________________________________________________
Address:
_________________________________________________________
Phone No:
________________________________________________________
E-Mail Address:
___________________________________________________
FOOD
PREFERENCES [Meals will be vegetarian, some with fish]
Special dietary requirements:
______________________________________________________
______________________________________________________
______________________________________________________
ROOM
PREFERENCE [check]
Multiple
occupancy (3 persons) [
] $ 395
Doubles occupancy (2 persons)
[ ] $ 480
Single occupancy (1 person)
[ ] $ 550
(limited
availability)
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,
Portola
Valley, CA 94028
SCHOLARSHIP FUND:
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
“Paneurhythmy
Circle of Joy.”
QUESTIONS:
Ardella Nathanael: (415) 499-8027
Bob Segbarth: herbnmin@aol.com
It would help our administrative arrangements if
you would send this in AS SOON AS POSSIBLE.