REGISTRATION FORM

Please Print and mail this form to:
Leah Wolfsong
51 Jordan Road
Buckfield, ME 04220

Women's Weekend Retreat
Rediscovering our True Selves
with Leah Wolfsong
April 21, 22, 23, 2005
Bear Mountain Inn, Waterford, Maine

Space is limited. To register, send payment in full by April 7, 2006!!! Please complete a separate registration form for each attendee.

Name: ____________________________________________________________

Address: ____________________________________________________________

____________________________________________________________

Phone: ___________________

Email:___________________________________

Please check the registration option you desire:

Complete Package

____ Room Option 1 $250

____ Room Option 2 $270

____ Room Sharing Option (Call Leah for price) _____

Meals & Workshop only

____ Per person $150

Enclosed please find my check made payable to:
Leah Wolfsong
51 Jordan Road
Buckfield, ME 04220