REGISTRATION
FORM
"ENCODING THE MESSAGE" WRITER'S RETREAT
Price: $125.00/per person
Please fill out the following information, sign and return as soon as
possible with designated deposit.
Name ____________________________________________________________________________
Name you wish to be called____________________________________________________________
Mailing address_____________________________________________________________________
Home phone _________________________Work phone____________________________________
Email_____________________________________Website__________________________________
Occupation_________________________________________________________________________
Birth date (month, day, year)________________Birth time and place___________________________
In case of emergency notify ___________________________________________________________
Phone_________________________________Relationship__________________________________
Signed_____________________________________________
Date__________________________
Registration Fee Enclosed ($125.00)
__________________________________
__ Check here if paying
online with Paypal (3% credit card fee will be added to transaction)
**Please make
checks or money orders payable to:
Wisdom & Wings and mail with registration form and fee to:
20218 St. Anna Drive, Avon, MN 56310
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