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Name :                                                                                    Private Bungalow    $325                                   

Address:                                                                       Semi-Private  Bungalow @$240/person                        

 City, St Zip :                                                                           Three Man Room @$160/person                        

Donation for those who cannot afford the cost:                        

Home Phone:                                                                              

Work Phone:                                                                                             Total Amount:                                  

(If you wish to choose your roommate in a shared room, submit applications for each together.)

Make Checks Payable to:
"SEARCH FOR SERENITY RETREAT"
and mail to  

Philip McWilliams Tax Services
9800 S. La Cienaga Boulevard, Suite 410
Inglewood, CA 90301

      If you choose, you may fax this registration for credit card payment to: (310) 915-1973

      Circle one:   American Express         Visa           Mastercard     

                                Total Amount to Charge (from above):                                         

                                                         Card Number:                                                    

                                                     Expiration Date:                                                    

                            Name as it appears on card:                                                            

                     Credit Card billing Address:                                                                  

                                                                                                                                 

                              Authorized Signature:                                                                 

                 (Credit Card Transactions will be processed by Philip McWilliams Tax Services, Inglewood, CA)