Please
first print this page and then fill out and mail to the address provided
below.
Registration
Form
Name:___________________________________________________
Address _________________________________________________
City_______________________________________
State________________ZipCode_____________
Telephone__________________________________
E-mail______________________________________________
Fax_______________________________________
Name of Program You are Registering For:
[ ] Bear
Medicine Program [
] Medicine Wheel
I
understand and accept that:
- I am responsible
for showing up for each week-end, physically and otherwise.
- I am
responsible for fulfillment of the financial obligations
of this program including tuition fees and all personal expenses,
including supply and equipment purchases and travel expenses.
- I am
responsible for acquiring and bringing the necessary supplies
and equipment for each week-end.
- I am
responsible for taking care of myself as an active member
of the community.
|
Bear
Medicine Program
[ ] I’ve enclosed the $200, non-refundable application fee.
If the full amount is paid by May 15th of the program year, there is a $200
discount, so that the program cost will be $1600. In addition, there is a $300
charge for materials that include a bear skin and other materials that you
will make your own to take home with you.
Medicine Wheel for Men or Women
[ ] I’ve enclosed the $200, non-refundable application fee.
The fee for the Medicine Wheel program is $2100. This includes food and housing
for all four weekends. If the full amount is paid by January 15th of the program
year, there is a $300 discount, so that the program cost will be $1800.
Payment
Plan
[ ] I am interested in a payment plan. I will contact the program
to make arrangements. No discounts are applicable for payment plans.
No refunds are rendered for cancellation within one
month prior to the start of the program you are registering for.
________________________________________________
Signature
Date
| Mail
Application and Payments |
One White Horse Standing
c/o Herb Stevenson
9796 Cedar Road
Novelty, Ohio 44072-9747
Herb can be reached
at 440.338.1705 or Fax 440.338.1784. E-mail
Herb
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