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