PEACEFUL PASSAGES

Sunday, September 29, 2002 o 8:00 AM to 5:00 PM
Ramada Regency Palace / Mt. Laurel, New Jersey

REGISTRATION FORM
(Please print this page and mail with your payment to 'send to' address indicated below)

Name: ___________________________________________________________

Address: _________________________________________________________

City: _____________________________ State: ____________ Zip: __________

Home Phone: ______________________________________________________

Work Phone: ______________________________________________________

E-mail: ___________________________________________________________

How did you hear about us?___________________________________________

Tuition: $125 includes lunch Full Payment Required

Cancellation Policy: Cancellations after September 1st will be charged $40

Check ___________ Money Order________________

Visa_____Mastercard_____ (sorry, no american express)

Credit Card Number ______________________________________________

Expiration Date__________________________________

Register Early - Enrollment Limited!

Make check payable to: Peaceful Passages
Send to: Peaceful Passages
Plaza Office Center Suite 102
560 Fellowship Road
Mt. Laurel, New Jersey 08054

Contact Information / Phone: (856) 727-8181 • www.peacefulpassages.org