Registration Form

Sign Me Up!

Registration Form

Your registration fee includes a choice of 30 classes from an extremely qualified staff, 6 organic vegetarian meals, healthy snacks, and breath-taking environment. What are NOT included in your registration fee are lodging and massages.

For lodge reservations contact the
Blue Bell Lodge, 1.888.875.000. For Campsites and Camping Cabins 1.800.710.2267. Mention the Reflections of Stillness Retreat.

REGISTRATION FEE • $344.50 (6% Tax included)

Please print, complete, and mail the following forms:
Completed Registration Form Liability Release Form
Class Choices (Program Overview) Check (to Mary Hensley)

Liability Release Form
Class Choices

Mary Hensley
5710 Sunburst Drive, Rapid City, South Dakota 57702

Phone: 605.390.8877
Email: hens1234@rap.midco.net

Name:

Address:

City:

State:

Cell:

Phone:

Zip:

Email:

Special Dietary Needs. (Include Written Explanation)

Please find me a roommate to share lodging.

I've included my registration payment of $344.50 (tax included)

Massage sessions are 1 hour long and the cost is $65 each. Make checks payable to the individual therapist on the day of massage. Space is limited; please specify first and second choices on the form below.

Friday

1st choice

2nd choice

Saturday

1st choice

2nd choice

2:00 pm

9:00 am

3:15 pm

10:30 am

4:30 pm

11:45 am

5:45 pm

1:00 pm

7:00 pm

2:30 pm

8:15 pm

4:00 pm

Sunday

1st choice

2nd choice

5:15 pm

9:00 am

7:00 pm

10:30 am

8:15 pm

PLEASE NOTE:

Refund requests for the retreat must be made in writing. A refund, minus a $50.00 processing fee, will be made for cancellation requests postmarked by September 19, 2008. No refunds after that date.