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2011 JEWEL HEART SUMMER RETREAT REGISTRATION Tibetan Buddhist

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2011 JEWEL HEART SUMMER RETREAT REGISTRATION Tibetan Buddhist Powered By Docstoc
					2011 JEWEL HEART SUMMER RETREAT REGISTRATION
Tibetan Buddhist Comprehensive Guide for Today’s Spiritual Traveler
Thursday, August 25 – Sunday, September 4
Please complete entire form. Return or send with $150.00 non-refundable deposit by July 22, 2011
Mail to: Jewel Heart, 1129 Oak Valley Drive, Ann Arbor, MI 48108 fax: 734-994-5577
Email: registration@jewelheart.org or call 734 994 3387 x 223.


Name(s):______________________________________________________________________

Address:______________________________________________________________________

City____________________________________State__________Zip:_____________________

Phone(s):_____________________________________________________________________

Email:_________________________________________________________________________

I am a member of Jewel Heart       Yes          No
I would like to become a Jewel Heart member and enjoy the retreat discount.
  Yes If yes, contact membership@jewelheart.org    Not at this time

Members: $450
Non-members: $550

Tuition ($450 or $550)               $________________________________

Donation to Scholarship Fund: $________________________________
Add $50 for registration
after July 22:                $________________________________

Total:                               $________________________________

Less Deposit Included:               $________________________________

Balance Due at Retreat:              $________________________________

   Check (payable to JEWEL HEART)                 Cash       Credit Card

Card# ___________________________________________Exp.___________________
 Mastercard  Visa  American Express  Discover

Signature ___________________________________________________________________
Deposit is non-refundable. Cancellation fees are donated to the scholarship fund.
_________________________________________________________________________________________
Describe any health concerns or physical disabilities ________________________________________________________
___________________________________________________________________________________________________________

For sangha lodging coordination - Contact registration@jewelheart.org. Please contact no later than July 22. Spaces
are limited, please request/respond early.
  I would like to stay in a Sangha member's home (please describe any allergies or special needs and whether or not you
will have a car) _______________________________________________________________________
  I have room at my home for retreat guests (please describe your proximity to JH and the available space- i.e. futon in den
or spare room with twin beds, and if you have pets, etc._________________________________________________________________
_______________________________________________________________________________________________________________________
                             Deposit is non-refundable. Cancellation fees are donated to the scholarship fund.
                          All gifts to the Scholarship Fund make a difference during this time of limited resources.
                         Thank you! If you need financial assistance, please contact registration@jewelheart.org.

				
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