Retreat ~ Booking/ Registration Form

To book a Retreat at the Centre, please contact us first so we can discuss your individual needs. Then please print out this form and post it to us, or we would be delighted to post a Course Registration form out to you if you prefer.

Registration Form for Accommodation Only (Not Courses)

Name .........................................................................................

Address.......................................................................................

....................................................................................................

Tel. No. (home)............................................................(work).......................................................

Email Address:.............................................................................

Accommodation required: single room (if possible)/shared room

for which I enclose a deposit of £50 (per person)

or full amount if less..................£... ..... (Please make cheques payable to the Self Realization Meditation Healing Centre. Thank you.)
OR
Debit my Mastercard/Visa/Visa Debit/Maestro/Solo/Electron (circle one)

No...................................................................
(Please send your credit card security number separately or ring us with details)

Expiry Date.......................

Solo/Maestro Issue No..........Solo/Maestro Start Date....................

Signature ..............................................

Name (as on card)....................................................................

Special needs .....................................................................................................................

...........................................................................................................................................

How did you hear of the Centre?

Recommended by ....................................................................................................

Magazine/paper/article in ........................................................................................

Leaflet/poster at........................................................................................................

Other........................................................................................................................

Please tick here if you DO NOT wish to be added to the SRMHC Mailing List - thank you.

Please print off this form and post it to us at the UK Mother Centre.
(Please do not e-mail the form to us. Thank you.)

Self Realization Meditation Healing Centre
Laurel Lane, Queen Camel, Yeovil, Somerset, BA22 7NU, UK.
Tel. 01935 850266
Fax. 01935 850234

Retreat ~ Booking/ Registration Form

Please print off this form and post it to us at the UK Mother Centre.(Please do not e-mail the form to us. Thank you.)

Please print off this form and post it to us at the UK Mother Centre.
(Please do not e-mail the form to us. Thank you.)