********************** RETREAT REGISTRATION FORM *****************************


Name: ___________________________________

Address: __________________________________

City: _____________________________________State ______ Zip: _________

M/F _______

Phone: _________________________

email: ______________________________________________

Please indicate any special dietary or other needs: ______________________________________


Registration Fee:   ___ $175       ___ $200        __ $225           Other $_______    

(50% deposit requested with your registration, the remainder is due by April 1st)  


Amount enclosed:  $_____________


Please make checks payable to “Insight Meditation of Cleveland”


Mail form and payment to:


 Insight Meditation of Cleveland

             PO Box 113

             Novelty, OH 44072



Please print this page, fill out the forrm, and send with your payment to register for the Apri 2017 retreat with Jon Aaron.