Name:________________________________________________________________
Address:______________________________________________________________
Town/City::____________________________________________________________
State:_________________ Zip:____________________________________________
Phone:_______________________________________________________________
Email:________________________________________________________________
I/We will stay in:
( )Tent ( )Cabin ( )RV
Per person rates (sliding scale)
( )Full retreat
$120-160
( )Saturday only $65
( )Friday evening $15
( )Saturday evening $15
Voluntary Contribution
( ) Add $__________
Help support Women's Circle and enable a woman to
attend who might otherwise not be able
to afford the registration fee
Make checks payable to:
Women's Circle
PO Box 99
Highspire, PA 17034