Robert Bly's Great Mother Conference - 34th Annual in 2008 at Camp Kieve, Maine

R E G I S T R A T I O N - F O R M

Please PRINT and then fill out this form and return with deposit

Register me for the 34th Annual
Conference on the Great Mother and New Father.
May 31- June 8, 2008 at Camp Kieve, Nobleboro, Maine
The fee for the conference is $885, with a $35 discount if one pays by cash or check.
Cost includes lodging and meals. I am paying as follows:

____ Charge my credit card $885.

____ A check for $850 is enclosed ($35 cash discount).

____ A check for the $100 cash deposit is enclosed. I will send a check for $750 by May 2nd.

Please make checks payable to:

Conference on the Great Mother & New Father

Full refunds on deposit available until April 15. Full balance due by May 2, 2008

I would like to make a contribution to the diversity /work/scholarship fund:
____$100 _____$50 _____$25 ____other

I am interested in:

____ Student Cost: $760 ($725 by check)

____ Work/Study Cost: $510 ($475 by check)

____ Diversity or Scholarship Opportunities
(Please submit a brief statement by April 1st, 2008)

____ I am interested in the Children’s Program.

____ Families: # of children/teens ____ x $510 each = $_________ ($475 by check)

____ I have a medical condition that requires special arrangements.
_________________________________________ (Please describe.)

____ This is my first time attending the Conference.
I found out about this conference through:_________________________

____ Please put me on your mailing list for information on future events

_________________________________________________________
Name
_________________________________________________________
Address
_________________________________________________________
City, State, ZIP
___________________________________________
Phone
_________________________________________________________
Email

When you register, please tell us how you heard about the conference. Thank you.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

If using credit card, please fill out the following:

___________________________________________
signature
___________________________________________
Print your name

Type of card: ____ Mastercard ______ VISA ______ CVV2 code on back_____

________________________________________expiration date______
Account Number

TOTAL CHARGE: $_______________________

Send registration deposit and balance to:

Great Mother Conference
c/o Jay Leeming
508 1/2 Utica Street
Ithaca, NY 14850

ROBERT BLY’S CONFERENCE ON THE GREAT MOTHER AND THE NEW FATHER

R E G I S T R A T I O N - F O R M

Conference on the Great Mother & New Father

Great Mother Conference
c/o Jay Leeming
508 1/2 Utica Street
Ithaca, NY 14850

ROBERT BLY’S CONFERENCE ON THE GREAT MOTHER AND THE NEW FATHER

R E G I S T R A T I O N - F O R M

Conference on the Great Mother & New Father

Great Mother Conference c/o Jay Leeming 508 1/2 Utica Street Ithaca, NY 14850

Great Mother Conference
c/o Jay Leeming
508 1/2 Utica Street
Ithaca, NY 14850