To register for an RCWMS program or retreat:

Send a check and the registration form to RCWMS, 1202 Watts St., Durham, NC 27701.

Event Title:

Event Date:

Your Name:

Address:

City/State/Zip:

Phone Number:

Day:

Night:

E-mail Address:

PAYMENT

___ I am paying a deposit of $_____ to reserve my place and will send the rest before the event.

(Deposits: $50 for one-day events, $100 for longer ones.)

___ I am paying the full event registration fee of $_____.

Paying by check

___ My check for $_____, made out to RCWMS, is enclosed.

Paying with credit card (VISA or M/C)

Amount being charged: $________

Credit card number: ____________________________________________

Exp. date: ___________________

Signature: ___________________________________________________

Special needs:

___ I have special needs (food, accessibility, etc.):