residential retreats registration form

The Lion’s Roar: Awakening Your Unshakeable Freedom of Heart
October 2-6, 2019 



Mobile: ______________________ E-mail: ___________________________________
Please describe your previous retreat experience (if this is your first retreat with Dori):



Please describe your intentions/aspirations for this retreat:



Lodging request
: Please indicate both 1st and 2nd choices     or   ___ no preference
___A-frame   ___hermitage   ___room in main house    ___room in Med Hall building

If more than 13 people register, are you able and willing to share a room with two beds?
___Yes   ___No   Roommate preference: ______________________
Please describe any physical ability needs related to your lodging request:


I am enclosing the registration fee of:  __ $215 Room __ $147 Camping
OR PayPal  Room__$222US or __$225 Int’l    Camping  __$152US or __$155 Int’l

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 and the request to remain onsite for the duration of the retreat (barring emergency):

_________________________________             ______________________________
Signature                                                                Date
Please sign & snail mail this form to: 4612 So. Schafer Branch Rd, Spokane, WA 99206
with a check payable to Dori Langevin or a copy of your PayPal receiptPlease keep a copy for yourself.