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Healing Retreat July 13-20,
2003
Name:____________________________________
Address:__________________________________
Phone:___________________________________
Fax:_____________________________________
e-mail:__________________________________
Fee: (Circle One)
$ 1200.00 CDN (plus $84.00 GST) includes
food and lodging
$ 800.00 CDN (plus $56 GST)
without food & lodging
Flexible payment plans are available.
For Visa payment, fill in information
VISA Card Number:____________________________
Expiry Date:__________________________________
Name on the card:_____________________________
Signature:____________________________________
Make cheque payable to: Susan Fraser
Send to: Fraser Counselling Services
256 King St. N.
P.O. Box 38007
Waterloo, Ontario, N2J 4T9
www.frasercounselling.com
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