AUDACIOUS AUTHENTICITY

GETTING COMFORTABLE WITH the UNCOMFORTABLE!

Unity Center's 9th Annual Summer Retreat

August 6-11, 2017

A separate registration form is required by each retreatant.

(Married/partnered couples may complete one form.)

Mail form to: Unity Center of Norwalk, 3 Main Street, Norwalk, CT 06851

or call the office to register over the phone 203-855-7922

PLEASE FILL OUT FORM IN FULL AND COPY FOR YOUR RECORDS.

Name: Mr/Ms:

Street Address:

City:                 State:                           Zip:

Phone (day): (evening): email:

□ Double (shared) room at $970 –This low price includes lodging, meals, & materials

I would like to room with: ______________________________________________

(If no preference, Unity Center will match you with a same-sex roommate.)

□ Single room at an additional $275.00 ($1245.00 total) (Limited single rooms available.

Check with office for availability. 203-855-7922)

□ Special Diet considerations. Explain your needs on the back:

□ $100 non-refundable deposit enclosed.

□ Full retreat payment enclosed

□ Check enclosed [ ] Cash (rec’d by _________________)

□ Payment Plan taken from my credit card of (check one):

□ 3 payments □ 6 payments

Credit Card type (circle one) Amex Visa Mastercard Discover

Card # ____________________________________ Exp _______ Security Code _____

Signature ________________________________________ Date _____ / _____ / _____

FULL PAYMENT IS DUE BY July 1st, 2017

THE BALANCE WILL BE CHARGED TO YOUR CREDIT CARD IF NOT RECEIVED BY DUE DATE

Refund Policy:

In order to receive a refund (minus the deposit), the following must apply:

There must be a same-sex replacement available and cancellation must be made by July 25, 2017.

No refund will be given after July 10, 2017.