Stories...A Lifewriting Retreat for Women

                    Registration Form


Name_______________________________________________________

Address____________________________________________________

       ____________________________________________________

Phone______________________________________________________

E-mail_____________________________________________________


Please sign me up for Stories: A Lifewriting Retreat for
Women, March 14-16, 2003, at the Trillium Retreat Center
on Vashon Island.

[ ] I am interested in carpooling from the Fauntleroy
    ferry dock. You may share my name and contact
    information with others who wish to share rides.

[ ] Please send me a ferry schedule.

[ ] Please send me information about other Capturing
    Memories lifewriting workshops.

[ ] Send me additional copies of this brochure.
    Quantity: ______

[ ] I have the following dietary restrictions:

    _______________________________________________________

    _______________________________________________________


            Registration Fee:    $264.00

Two or more registrations
sent together, deduct $14.00:  - _______

     Other Discounts/Coupons:  - _______

                    Subtotal:    _______

I am registering by Dec. 31,
      deduct 10% of subtotal:  - _______

              Total Enclosed:    _______


You will receive a confirmation packet, including directions to
Trillium, items to bring, and a detailed workshop schedule in the
mail after January 15.

Send check or money order and this form to:

        Capturing Memories
        9228 SW 209th Street
        Vashon, WA 98070