Converging Storms 2010 Registration | Converging Storms Action Network

Sign up for the Converging Storms 2010 Class
Sundays, March 14 - April 18, 2010, 2:00-6:30 p.m.
Flintridge Retreat Center, 236 W. Mountain St. Suite 117, Pasadena, CA 91103

Name: *

Street Address:

City:

State:

Zip Code: *

E-Mail Address:

Day Phone:

Evening Phone:

Organizational Affiliation (if any):

Registration Fees: *

Please indicate amounts paid below
(no one turned away for lack of funds - if you need a fee waiver, select "Need Fee Waiver Scholarship")

Extra Donation to Help Fund Scholarships: $

(optional)

Registration Fee Given To:

(print name of person if given in person, or if mailed, write "Mailed To P.O. Box")

Date Paid:

Third Party Registration:

If you are registering for someone else, please add your name here.

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