Contact Information:

• Name ________________________________________________
  

• Address _____________________________________________
  

• City, State ________________________________________
  

• Phone ___________________________ Cell Phone ___________________________
  

• E-mail __________________________ Date of Birth _________________________
  

  (contact information to be used for retreat purposes only)
  

Program Fee:

• $150 in advance (by April 20)
• $175 at first session

Checks for the registration fee should be made out to the Foundation for Astronomy and Spirituality, Inc. and sent to:

Dr. Joyous Judy Young
Foundation for Astronomy and Spirituality, Inc.
9 McClure St.
Amherst, MA 01002