Registration Form

Name

Address

City

State              Zip

Phone

Email

Attending                 3 days             2 days   

Single room       (add $40 -for 2 days- or $60 -for 3 days-
                                to the cost of the retreat)

Roommate request

Dietary requests

Special needs

Please mail this completed form, along with your $75 deposit to:

Andreas Weinrich, 1104 S Park Ave, Bloomington IN 47401.

Please make the check payable to Andreas Weinrich.