Local Women's Retreat - Registration Form

Deep Green's Local Women's Retreat:
Cultivating Peace through Yoga, Art, Aromatherapy, and the Garden

May 22 - 23, 2010
Hosted by Gaia Healing Center, Mt. Airy, Maryland

* All fields are mandatory
Name:
Address:
City:
State:
ZIP:
E-Mail:
Phone:	(xxx) xxxxxxx
Date of Birth:	(MM/DD/YYYY)
Roomate Request:	Yes No
Roomate Name:
Special Dietary Needs:
Reflective Questions:
I am most looking forward to:
I hope to gain:
	Early Registration Discount (by 4/22): $252.35 $245 + $7.35 service fee
	Regular Price: $267.80 $260 + $7.80 service fee
	Work-Study (Spaces Limited): $200.85 $195 + $5.85 service fee
	Payment through

• Total cost includes one night accommodation, lunch and dinner on Saturday, and breakfast and lunch on Sunday. Snacks and tea are available both days. Registration begins on Satruday at 8:00 am. Activities begin promptly at 9:00 am and end on Sunday at 4:00 pm. A Pre-Retreat Welcome packet will be emailed to you prior to the retreat.