Radiant Mind ~ Open Heart:
Awakening from the Illusion of our Separateness
6:00 pm Wed, Sept 20 thru 1:00 pm Sun, Sept 24, 2017
Phone: ______________________ E-mail: __________________________________
Please describe your retreat experience (if this is your first retreat with Dori):
Please describe your intentions/aspirations for your retreat experience:
Lodging request: Please indicate 1st and 2nd choices or ___ no preference
____A-frame ____hermitage ____ room in main house ____room in barn
Please describe any physical ability needs related to your lodging request:
If more than 13 people register, are able and willing to share a room?
___Yes ___No Roommate preference?: ______________________
I am enclosing:
____ $200 deposit; $150 refund with phone call to Dori by Sept 6
____ PayPal $207; $150 refund with phone call to Dori by Sept
____ $132 Camping deposit; $82 refund with phone call to Dori by Sept 6
____ PayPal $137 Camping deposit; $82 refund with phone call to Dori by Sept 6
In addition, I would like to contribute $_______ to the scholarship fund. Thank you for your generosity.
I understand and agree to the refund policy for this retreat:
Please sign & mail this registration form to Dori at: 4612 So. Schafer Branch Rd, Spokane, WA 99206
with a check payable to Dori Langevin or a copy of your PayPal receipt.