We are what we Eat. We are what we Think!

5th ~ 11th January 2010

Please complete the following details and press Submit. You will then be taken to PayPal’s secure service to make your payment.

Name
Address
Number of people	( = Male + Female )
Email address
Phone/mobile/cell
Occupation
Food preference (vegetarian)	Cooked Raw
What, if anything, would you like to achieve during the retreat?
It is important that we know if you or anyone in your party has a health issue.
Any medication being taken? If none, please state 'none'
Any physical health issues? If none, please state 'none'
Any mental health issues? If none, please state 'none'

Please press the button only once