2012 Search for Serenity Retreat

October 19 – 21, 2012

Registration Form

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Please complete and return this form with your payment to our address below. If you wish to pay by credit card, you may do so by following the instructions below the registration information.
Registration Information
Name:  
Address:  
 
City:  
State, Zip:  
Home phone:  
work or other phone:  
e-mail:  
Please provide at least a phone number or e-mail address
Please choose accommodation type
Private bungalow $325 $_______
Two-man bungalow $240 per person $_______
Three-man room $160 per person $_______
Contribution to help those who cannot afford the cost: $_______
Total amount enclosed: $_______

If you wish to share a room with specific rommates, please submit all your applications together, and note that they're for the same room.

Make checks payable to Search for Serenity Retreat, and mail to:

Search for Serenity Retreat, c/o Phil McWilliams Tax Services
9800 S. La Cienaga Blvd. Suite 410
Inglewood, CA 90301

If you'd like to register and pay by credit card, you may fax this form
with the additional information below to (310) 216-9169

Please circle one:     Visa    Master Card    American Express
Total amount to charge, from above: $  
Card number:  
Expiration date (month/year):  
Name as it appears on card?  
Credit card billing address:  
 

(Credit card transactions will be processed by Philip McWilliams Tax Services, Inglewood, CA)

For additional information or questions, please call Phil at (310) 649-0038