Registration for
2012 Advanced Manifestation Workshop
with
Rick Jarow

November 9-11, Ananda Ashram

all fields are required

Your Name

Gender
 M F

Your Email

Phone

Please select which experience you've had with Rick in the past:
 workshop one-on-one consultation manifestation cafe

Dorm (4-6 to a room) or Off-site (will find own accommodation):
 dorm off-site

Would you like to stay for dinner at the Ashram on Sunday night following the workshop? ($8.00 additional) Please note: Final decisions on this (as we need to notify the Ashram) must be made by, and cannot be changed after November 4th.
 Y N

Please indicate if you are registering as a couple so that we may apply your discount:
 Y N

If so, your partner's name: