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					                                                   Registration Form
                                          Renovate Your Life Retreat
                                    September 27, 2012 – September 30, 2012

                                                Hope Springs Institute
                                                   Peebles, Ohio

                                  Give yourself the gift of investing in two and a half days to
                                  break free from what’s holding you back and discover the
                                      courage, power, and passion to fulfill your dreams.



Full Name: ___________________________(First name for badge)______________________________
Preferred Mailing Address: ______________________________________________________________
City: ________________________State/Province: ___________Zip/Postal Code: _________________
Country: __________ Telephone: (______)____________ Email: _______________________________


1. Registration Fee (All fees listed in U.S. Funds.) Includes shared room, 8 meals, and retreat materials.
                                                                    POSTMARKED & PAID
   PLEASE CHECK APPROPRIATE REGISTRAION FEE:             BEFORE/ON AUGUST 1       AFTER AUGUST    1
   Renovate Your Life Retreat                                   $639                  $689


Please list any ADA Special Needs: ____________________________________________________________
_
Please list any Dietary Restrictions: ___________________________________________________________

Please list an Emergency Contact: _____________________________________________________________


Cancellations/Changes and Refunds: Fees for missed meals, late arrivals, and early departures will not be
refunded. Fees will be refunded, less a $50.00 processing fee, if cancellation or change resulting in a refund is
received in writing no later than September 1, 2012. After that date, fees are non-refundable.


PAYMENT METHOD - Check or Money Order must be in U.S. funds payable to: Donna Johnson. There will be a
$25.00 fee charged on checks returned by the bank due to insufficient funds. Registration confirmation/receipt and
further information will be mailed.

Please check appropriate box:  Check  Money Order  PayPal (credit cards accepted through PayPal – an invoice
will be sent to you for payment if this box is checked)


Please mail completed registration form to:                               For More Information Contact:
Donna Johnson, Renovate Your Lifestyle                                    Debra McNealy-Hoelscher
1909 Claremont CC Commons                                                 boomerangsandbutterflies@gmail.com
Normal, IL 61761                                                          309.838.7433

                                                                          Donna Johnson
                                                                          309.825.0956
                                                                          donna@renovateyourlifestyle.com



                        Program information at http://renovateyourlifestyle.com/events/retreat

				
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