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Retreat Registration

Registration form for Annie Nugent and Sky Dawson
May 14-23 2010

9 nights - retreat ends Sunday May 23.

Your registration will only be finalised once your deposit is received into the PIMG account. Please complete the following information.
Scholarships are available on request.

*Denotes required field.
* Personal Information:
*First Name
*Surname
Name you wish
to be called
*Street Address
*Suburb
*State
*Postcode
*Gender
* Phone
Landline or Mobile
(please include
area code)
*email address
 

only fill in your email address
if you check it at least once a week
*Confirm
email please
 
* Retreat Dates May 14-23
*Full or Weekend retreat

FULL: 14 May - 23 May 2010
N/A
N/A
Weekend - 14 - 16
Weekend 14-16 plus extra nights
* Dates Attending
Date Arriving
Date Leaving
Approx Time of Leaving
* Special Requirements
Dietary Requirements

NO special food requirements
I require dairy free food
I require wheat free food

 

NOTE on Special Dietary Requirements: We can cater for a small number of dietary requirements. A refrigerator is available for medicine and other personal special food items.

Any other relevant information you would like us to know?
(eg: medical or mobility needs)
Cost*
Preference will be given to those who regster for the FULL Retreat.
Minimum deposit of $100 required to register.
Choice 1: Full retreat 9 nights: 14 May - 23 May 2010

Choice 2: Weekend 14-16 May
170
Choice 3: Weekend 14-16 May plus extra nights
+ $45 per extra night =

 
 
 
 
 

 

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