The Wonders :: Retreat Registration Form

Retreat Registration Form

Personal Information
First Name *
Last Name *
Address *
Address (line #2)
City *
State/Province *
Country *
Postal/Zip Code
Telephone Number
E-mail *
Select Retreat *
Select Room type *	Please note: Registration closes June 15, 2012
Select Accomodation *
Select Meal Plan *
Select Recording *
Rooming Preference (Who with - optional)

Billing Information Please note: a deposit of 25% of the registration fee selected will be billed to your credit card upon submission of this form. A further 25% will be billed on March 8/12. The balance of 50% will be billed on May 25/12. Please make note and arrange for credit card payments to be processed on time. A $100 fee will apply for any payments declined at time of processing. All payments are non-refundable.
Cardholder's Name *
Credit Card Number: *
CCV (3-digit code on back of card) *
Expiry Date (mm/yy) *
Special Instructions: