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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, 2010Name__________________________________________________
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!