Register for II

Awakening To Truth

A Journey into Self Realization

Please print clearly and fill out completely. Registration Date: M D Y

Name	Male	Spouse/Partner	Male
	Female		Female
Address		Address

City		City
State/zip	Country	State/zip	Country
Home#		Home#
Cell#		Cell#
Work#		Work#
Email		Email

Date Location Meals & Accommodations

June - 15-19, 2012 26340 Old Wagon Rd. $597.00

Escondido, CA 92027

To pay now by credit card, use the secure payment button at the bottom of this page or, if you

desire a Payment Plan, please insert amounts and due dates and credit card information below.

(last payment must be received by Nov. 15, 2011) NOTE: if you are paying with credit card or PayPal there is an $18 surcharge

If paying by check, mail to: Linda Robinson 2640 Worden St. #215 San Diego, CA 92110

Due to prepayment requirement at the retreat center, refunds are not available.

Amount	Date Due	Amount	Date Due		Amount	Date Due	Amount	Date Due
$		$			$		$

_________________________________ ____________ _________

Credit card number Expiration date Security Code

_____________________________ _________________________________/______

Full name on card Authorized signature Date

Please print this form and fax it to: (619) 819-9996

Illumination Intensive presented by The Get A Life Co. Facilitated by Linda Robinson

619-222-2543 awakeningtotruth@cox.net www.awakeningtotruth.com

NOTE: if you are paying with credit card or PayPal there is an $18 surcharge = $615.00