Waking Up to the Love That is Here Waitlist
May 30 – June 3, 2018 * Kairos * Dori Langevin
Phone Cell: ______________________ E-mail: _______________________________
Please describe your previous 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
If more than 13 people register, are you able and willing to share a room?
___Yes ___No Roommate preference: ______________________
Please describe any physical ability needs related to your lodging request:
I am enclosing registration fee of:
____ $200 ($100 refund with phone call to Dori by May 2)
____ PayPal $207 ($100 refund with phone call to Dori by May 2)
____ $132 Camping ($32 refund with phone call to Dori by May 2)
____ PayPal $137 Camping ($32 refund with phone call to Dori by May 2)
In addition, I would like to contribute $_______ to the scholarship fund.
Thank you for your generosity.
By signing below, 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.