GODDESS REVEALED

September 19-26, 2015 held in Tuscany



Please fill out a registration form for each person attending.

Contact Information
As it appears on your passport

*Last Name: Middle Name:

*First Name:


*Email: Secondary Email:


*Home Phone: Cellphone: Work Phone:


Street Address: City:


Prov./State: Postal Code/Zip:

Special Dietary Requirement

Special Requests


Special Rate if you book before August 10, 2015
Double Rate $4500.00 per person
Single Rate  $5500.00 per person
(flights not included)

Bookings after August 10, 2015
Double Rate $5200.00 per person
Single  Rate $6200.00 per person

$1000.00 deposit to be paid by August 10, 2015

Balance of Payment to be paid in full by August 14, 2015