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Name : Private Bungalow $325
Address: Semi-Private Bungalow @$240/person
City, St Zip : Three Man Room @$160/person
Donation for those who cannot afford the cost:Home Phone:
Work Phone:
Total Amount:
(If you wish to choose
your roommate in a shared room, submit applications for each together.) Philip McWilliams Tax Services
If you choose, you may fax this registration for credit card payment to: (310)
915-1973
Circle one: American Express
Visa Mastercard
Total Amount to Charge (from above):
Card Number:
Expiration Date:
Name as it appears on card:
Credit Card billing Address:
Authorized Signature:
(Credit Card Transactions will be processed by Philip McWilliams Tax Services, Inglewood, CA)
Make Checks Payable to:
"SEARCH FOR SERENITY RETREAT"
and mail to
9800 S. La Cienaga Boulevard, Suite 410
Inglewood, CA 90301