I Have Stilled and Quieted My Soul - Individual Registration

First Name *

Last Name *

Address *

City *

Zip *

State *

Phone *

Fax

Email *

Comment

1. Are you a part of a Centering Prayer group?

Yes

No

If yes, what Group name or Location

2. Do you have a regular Centering Prayer practice?

Yes

No

3. Is there a need for an Intro to Centering Prayer Workshop in your area at a later date?

Yes

No

Not Sure

Optional - Donations

$00.00

$20.00

$25.00

$30.00

$40.00

$50.00

$75.00

$100.00

Vegetarian Lunch

Yes - Vegetarian

No - Vegetarian

Amount

$

Payment Method

Paypal - The Paypal site also accepts credit or debit cards.

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Individual Registration