Northwoods Serenity Retreat Registration Form

All payments must be made in full by May 15, 2008.
Cancellation Policy: Refunds less $350.00 will be made
if cancellation is received before April 30.
There are no refunds for cancellations after April 30.

Full Name: *

Street Address: *

City: *

State (for USA): *

Province (outside USA):

Zip Code:

Country: *

Company name (optional):

Daytime phone (include area code and/or country code): *

Evening phone (include area code and/or country code): *

Email address to send a receipt (optional):

Website (optional):

http://

Today's date:

mm/dd/yyyy

Will you be flying and/or driving to the retreat (select all that apply)?

		Flying in
		Driving in (local)
		Driving in (rental car)
		Carpooling

Would you like a resource for air, ground transport
and/or car rental coordination in Minnesota? (select all that apply)

		Airline/Airport information
		Ground Transportation
		Car Rental
		Walleye Fishing

Do you have any special needs?
(Gluten intolerant, lactose intolerant,
need to be by a bathroom, use wheelchair, etc)
*

Method of payment? *

Make sure you are happy with your answers above.

Make your check payable to:
Design Your Destiny LLC
30236 Pumpkin Hill Rd
LeSueur, MN 56058
If you have any questions, please don't hesitate to call me at 507-665-3358

I look forward to your participation!

* = Input is required