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            NEW FOR THE NEW YEAR!!!!!!!!!!!
              
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still learning, inc./Institute of Poetic Medicine Offer

CIRCLE OF TRUST RETREAT APPLICATION

The Journey to the Undivided Life:

RECLAIMING YOUR HIDDEN WHOLENESS through the

HEALING POWER OF POETRY

                               September 10-12, 2010

Name__________________________________________________                                                                       

Address_________________________________________________

________________________________________________________

Phone Numbers:  H___________________                   W_________________

CELL_______________________________FAX

E-mail___________________________________________________                                                                          

Personal statement:  To help us discern how participating will both serve you and allow us to better plan the program, please include a personal statement (not more than two pages) with your registration:

·         How you learned about this circle of trust retreat;

·         Why you are interested in participating, and how you hope to benefit personally and/or professionally.

Program costs: 

 ______$889. My check made to still learning, inc is enclosed

with this registration form and my personal statement

Special Dietary Needs:

If you have any other special needs, please let us know as soon as possible, so that we can do our best to accommodate you.

To register send the registration form, personal statement, and a check to:

Dr. Sally Z. Hare

still learning, inc.

P O Box 14028

Surfside Beach, SC 29587

SEE "PROGRAMS" FOR EARLY REGISTRATION SPECIAL! 

click here for early registration discount information

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CIRCLE OF TRUST RETREAT APPLICATION
Journey Toward an Undivided Life

October 29-31, 2010

Name_________________________________________________



Address_______________________________________________


Phone Numbers:

H                                                   W_____________________

Fax __________________

E-mail ________________________________________________

Personal statement: To help us discern how participating will both serve you and allow us to better plan the program, please include a personal statement (not more than two pages) with your registration:

• How you learned about this circle of trust retreat;
• A brief description of the setting in which you currently

do your work
• Why you are interested in participating, and how you hope to benefit personally and/or professionally.
Program costs:

_____ $675.00 private room

 _____ $575.00 sharing a room with________________

Special Dietary Needs:


If you have any other special needs, please let us know as soon as possible, so that we can do our best to accommodate you.

To register send this registration form, personal statement, and a check payable to:

 
Haqiqa Bolling
220 Kings Hwy.
Decatur, Ga. 30030

EARLY BIRD DISCOUNT by September 1st
$575 private room, $475 shared room

Cancellation policy: Cancellations are subject to a $50 administration fee, and must be made at least 2 weeks prior to the program date to receive any refund.

For further information, please contact:
Haqiqa Bolling: 404-377-7035, haqiqa@aol.com