REGISTRATION FORM
 Dharma Friends
2009 Mindfullness Retreat

Name:_______________________________________________

Address:_____________________________________________

City/State/Zipcode:_____________________________________

Phone: _____________________________________________

Email:_______________________________________________

        ____Male _____Female

Dietary restrictions, requirements, preferences:

____gluten intolerance _____lactose intolerance _____ other (please specify)

Grace Lodge/ All Good Gifts Lodge… cabin- shared occupancy

        ______ 5 days - $600

All Good Gifts Lodge - single occupancy

        ______5 days - $640

Cabin- Dormitory

        ______5 days - $500

Tent       

        ______5 days - $340

______Scholarship Fund amount ___________

______ Dana amount ___________

            TOTAL:___________            Total Enclosed: ___________

Make checks payable to: Annee Littell
    Mail to     Annee Littell
                  517. E. Johnson St.
                  Fayetteville, AR 72701