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To register,
print this page and mail with your payment in full to: Retreat date: _______________________________________________________________ Location: __________________________________________________________________ NAME: ___________________________________________________________________ ADDRESS: ________________________________________________________________ EMAIL ADDRESS: _________________________________________________________ PHONE/FAX: ______________________________________________________________ Previous Intensives attended, if any: ____________________________________________ __________________________________________________________________________ __________________________________________________________________________ What I want to get from this Intensive experience: ________________________________ __________________________________________________________________________ Current state of health: ______________________________________________________ |