From Intention to Reality:
A Ritual Approach

RETREAT REGISTRATION FORM

Name_____________________________________________________

Address___________________________________________________

City_______________________State______________Zip___________

Email_____________________________________________________

Day Phone___________________ Eve. Phone_____________________

Check payable to The Institute in amount of $___________________

*********************

Early registration is encouraged due to space capacity.
Please send deposit (minimum $135) check made payable to: "The Institute."

Mail check w/this form to:
IAPH, 80 Fifth Avenue, Suite 1507, New York, NY 10011

Deposits refundable until Sep. 17, 2004, nonrefundable thereafter. Confirmation and directions will be sent on receipt of this registration form.