February 10, 2011- February 12, 2011

$40 Early Registration Fee before January 24th for Wabash Friends Church Attendees
$50 Registration Fee after January 24th for Wabash Friends Church Attendees
$75 Registration Fee before January 24th for non Wabash Friends Attendees
$85 Registration Fee after January 24th for non Wabash Friends Attendees
$60 Registration Fee before January 24th for groups of 5 or more from the same church

Name: ______________________________________
Spouses Name: ______________________________
Address: _____________________________________
City: __________________________________________
Zip Code: ______________________________________
Phone: ________________________________________
Email: _________________________________________
Handicap Accessible Room: Yes____ No____
Smoking or Non- Smoking Room:   Smoking _____ Non- Smoking ______
Check if you prefer a Queen Size Bed rather than a King Size ($79.99/night for all rooms) _____
Church You Attend: ____________________________
Massages
____ 15 Minute Chair Massage ($10/person)
____ Swedish massage ($35)

Total Amount Due: $___________

*Make Checks Payable to: Wabash Friends Counseling Center
* We also accept Debit/Credit Cards