Registration Form
Gaia's Womb Presents "Invocation" March 2, 3, & 4, 2012 DeKoven Center, Racine, WI
Please Print Clearly.
Name:
Address:
City, State, Zip:
Phone Day/Evening:
E-mail:
Enclosed is my check for: $___________ I am enclosing an additional $___________ to be contributed to the Scholarship Fund.
Meals:	Please circle one:  Vegetarian  /  Non-Vegetarian * All meals are included. Vegetarian selections are limited. If you have special dietary concerns there are microwaves and refrigerators available. Please bring your own food. We regret that we cannot make a price adjustment for this.
Pricing Structure: DeKoven Center is located on the shores of Lake Michigan in Racine, Wisconsin. Directions will be provided upon receipt of registration. $325.00 for registrations postmarked prior to January 20th, 2012. $355.00 for registrations postmarked betweenr January 21st and February 10th, 2012. $385.00 for registrations postmarked after February 10th, 2012. The price includes programs, meals, and accommodations. Rooms are semi-private. Bathrooms are shared. No refunds. Is this your first Gaia's Womb event? If this is your first Gaia's Womb event, how did you hear of us? Mail completed registration form to: Gaia's Womb c/o Angie Buchanan P.O. Box 647 Deerfield, IL 60015 Please make checks payable to: Gaia's Womb For further information contact Angie Buchanan at telephone: (847) 456-4833 email: angie@gaiaswomb.com