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New Hampshire
Butterfly
Registration Form
Discover Happiness Adventure - Hanover, New Hampshire 2006
September 15, 2006 - September 17, 2006

This Registration Form and a $200 non-refundable deposit are required in order to reserve a space in Discover Happiness Adventure - Hanover, New Hampshire 2006
*  Denotes required fields

Name: *  
Street: *  
City: *  
State: *  
Zip: *  
Home Phone: *  
Work Phone: *  
E-Mail Address: *  
Retreat Fee: $825

Please complete one of the following two choices:

Choice One:
Check      I am enclosing a check (made out to Connected Lifestyles*) for:
Entire Event Fee of $825
OR
Deposit of $200, along with a post-dated check for the balance of $625 (must be paid in full by August 1, 2006)
Choice Two:
PayPal      I am using PayPal to deposit funds to the bank account of Connected Lifestyles:
Entire Event fee of $825
OR
Deposit of $200, to be followed by a payment covering the balance of $625 (must be paid in full by August 1, 2006)
Registration Choice One (Use one of the three options below)
  1. Mail Registration Form and check(s) to Connected Lifestyles, address below
  2. Fax Registration Form to (310) 450-4074 and mail check(s) to address below
  3. E-Mail Registration form to carol@carolsegrave.com as an MS Word attachment and mail check(s) to the address below
Please make checks payable to CONNECTED LIFESTYLES.

Registration Choice Two (Follow both steps below)
  1. Pay using PayPal - click on the button below and follow the instructions to make a payment. You will be able to select the dollar amount, giving you the option to pay in full or pay only the deposit.



  2. Submit Registration form in one of three ways: Mail Registration Form to Connected Lifestyles (address below) OR Fax Registration Form to (310) 450-4074 OR E-Mail Registration form to carol@carolsegrave.com as an MS Word attachment
  Mailing Address:

  Carol Segrave
  Connected Lifestyles
  1941 Euclid Street # 4
  Santa Monica, CA 90404

  Contact Carol:
  E-Mail:  carol@carolsegrave.com   Telephone: (310) 450-4074

The cost of the event is $825 per person and includes all lodging, meals, yoga, meditation and workshop sessions. Fee does not include air fare, drinks or any unscheduled transportation. A non-refundable deposit of $200 will reserve your space. The balance of $625 is due by August 1, 2006.

Contact Carol at (310) 450-4074 or at carol@carolsegrave.com to set up a scholarship or monthly payment plan.

CANCELLATION POLICY
Cancellations must be made by phone and confirmed in writing to Carol Segrave. If you cancel your reservation more than 30 days prior to the start of the event, we will retain your non-refundable deposit of $200 but return the balance to you. If you cancel fewer than 30 days prior to the start of the event we will retain your entire payment. This forfeited payment can, however, be applied to another event within one year.

Connected Lifestyles reserves the right to cancel an event at any time. Should this be necessary, your entire payment will be refunded to you.Your signature indicates that you understand and agree to the above terms and conditions.

Please sign and date:
Sign:     
Dated:  
*Connected Lifestyles is the name of Carol Segrave's consulting firm.
    © 2005 Carol Segrave Site: Indax