PLEASE EMAIL TO : info@tipilifestyles.com

    OR if you have trouble downloading this form,let us know & we will email it to you:                                                     

DATE:_______________

NAME:_________________________________________________________

ADDRESS:______________________________________________________

CITY,STATE, ZIP:________________________________________________

PHONE:_______________________CELLULAR________________________

EMAIL:__________________________________________________________

PERSONAL INFORMATION:

AGE: __________________ GENDER: _____________

ALLERGIES or MEDICAL CONDITIIONS:____________________________

_________________________________________________________________

PHYSICAL LIMITATIONS (if any):__________________________________

_________________________________________________________________

DIETARY RESTRICTIONS:_________________________________________

   I EAT ___CHICKEN ___FISH ___BEEF ____ I AM VEGETARIAN

Emergency Contact: _____________________________________________

RESERVATION CHOICES FOR AUGUST 25-31, 2008:             

please choose one: 

  ______Shared room & Bath                               @ $1500./single.

  ______private room w/ double bed                  @ $1625./single or  $3125/couple

  ______PRIVATE ROOM  w/ Queen bed & bath   @ $1700./ single or $3200/couple 

Deposit of 50% due 30 days prior to Retreat date to reserve your space.

Cancellations after that time, forfeit deposit.

____________________________________________________________________________

I AM REGISTERING FOR THE AUGUST 25TH RETREAT AND ENCLOSING A CHECK FOR: ___________50% Deposit. I will remit the balance by July 25, 2008,

___________Full Payment

signed: _____________________________

(If you wish to pay by credit card, please call us with your card information.)