daylong meditation retreats registration form

Name:____________________________________________________________________

Address:___________________________________________________ Zip____________

Phone: ___________________________ E-mail: _________________________________

Are you new to mindfulness meditation? __­_ Yes ___ No

I understand the refund policy:_________________________________________________
Signature

Please sign & mail this registration form to Dori at: 4612 So. Schafer Branch Rd, Spokane, WA 99206
with a check for $45 – $65 payable to Dori Langevin or a copy of your PayPal receipt.