Retreat Registration Form

~ May all beings be free from suffering ~

********************** METTA RETREAT REGISTRATION FORM *****************************

Name: ___________________________________

Address: __________________________________

City: _____________________________________State ______ Zip: _________

M/F _______

Phone: _________________________

email: ______________________________________________

Please indicate any special dietary or other needs: ___________________________________________

Registration Fee: ___ $165 ___ $185 __ $200

(50% deposit requested with your registration, the remainder is due by April 15th)

Amount enclosed: $_____________

Please make checks payable to “Insight Meditation of Cleveland”

Mail to: Insight Meditation of Cleveland
PO Box 113
Novelty, OH 44072

Please print this page, fill out the form, and send with your deposit to register for the April retreat with Chas DiCapua.