Geneen Roth Workshop Registration

Registration Payment Policy:

$595 minimum down payment ($350 non-refundable/non-transferable) due upon registration.
Payment by accepted credit cards or check (made payable to "Reflections & Revelations").
Balance of retreat fees are due 12 weeks before the first day of the retreat. If paying by credit card, any balance due on that date will be charged to credit card on file.
If using a payment plan, payments by credit card or check must be made on specified plan dates.

Cancellation Policy:

Cancellations must be requested in writing to "Reflections & Revelations" (email, fax, or USPS).
Cancellations received 8 weeks or more prior to the first day of the retreat: You will receive a full refund less a $350 non-refundable/non-transferable administration fee.
Cancellations received between 8-4 weeks prior to the first day of the retreat: You will receive a 50% credit of the registration fee to be transferred to the next scheduled Reflections & Revelations Retreat. This credit is available only if your cancelled space is filled with another registration prior to the start of the retreat. The credit is null and void if not used at the specified retreat.
Cancellations received less than 4 weeks in advance of the first day of the retreat: No refunds, transfers or credits will be given for any reason.

I hereby confirm that I have read and understand the Registration & Cancellation Policies and agree to these terms. I understand that these policies apply to this and future retreat registrations, unless revised by Geneen Roth & Associates, Inc.

Signature _________________________________ Date ____________

Reflections and Revelations - The Retreat
Geneen Roth Workshops FAX/Mail Registration Form You can view this form without obligation to submit payment!
I prefer to return to the Geneen Roth site now!

OCTOBER Reflections and Revelations Retreat -- October 28-November 2, 2008


*Personal Information Indicates required information**
First Name *
Last Name *
Billing Address *
City *		State/Province*
Zip/Postal Code *		Country
Phone (evening)		Phone (day)
FAX
Date of Birth
Email Address *

Profession

How did you hear about the retreat? * Workshop If you selected workshop - which workshop? Book Friend or Family Member Therapist Magazine If you selected magazine - which magazine? Other If you selected other - please specify where.

If you received a brochure in the mail, please enter the P.R.code here
Check here if, under the Americans with Disabilities Act, you require specific aids or services.

Reflections and Revelations Retreat Workshop Fees

Triple/Foursome - $1420.00 Double - $1520.00

Charge Full Amount Now Charge $595.00 Deposit Only

Pay either with a Credit Card or by Check/Money Order
Make Check/Money Order (US $ only) payable to: Geneen Roth & Associates Inc.
Credit Card		Card Number
	Visa
	MasterCard
		Cardholder name as shown on card

Registration & Cancellation Policies Note: Only signed registrations will be accepted. Registration Payment Policy: $595 minimum down payment ($350 non-refundable/non-transferable) due upon registration. Payment by accepted credit cards or check (made payable to "Reflections & Revelations"). Balance of retreat fees are due 12 weeks before the first day of the retreat. If paying by credit card, any balance due on that date will be charged to credit card on file. If using a payment plan, payments by credit card or check must be made on specified plan dates. Cancellation Policy: Cancellations must be requested in writing to "Reflections & Revelations" (email, fax, or USPS). Cancellations received 8 weeks or more prior to the first day of the retreat: You will receive a full refund less a $350 non-refundable/non-transferable administration fee. Cancellations received between 8-4 weeks prior to the first day of the retreat: You will receive a 50% credit of the registration fee to be transferred to the next scheduled Reflections & Revelations Retreat. This credit is available only if your cancelled space is filled with another registration prior to the start of the retreat. The credit is null and void if not used at the specified retreat. Cancellations received less than 4 weeks in advance of the first day of the retreat: No refunds, transfers or credits will be given for any reason. I hereby confirm that I have read and understand the Registration & Cancellation Policies and agree to these terms. I understand that these policies apply to this and future retreat registrations, unless revised by Geneen Roth & Associates, Inc. Signature _________________________________ Date ____________

I prefer to return to the Geneen Roth site now!
Please Print and either Mail or Fax to: Geneen Roth & Associates Inc. P.O. Box 2852 Santa Cruz, CA 95063 Fax - 831-685-8602 Voice - 831-685-8601 or 877-243-6336 (toll free)