PRINT THIS PAGE, FILL IT OUT, AND SEND IT, ALONG WITH PAYMENT TO KILOBY FOUNDATION, PO Box 232, Mt. Vernon, Indiana 47620
Name/Names: _____________________________________
________________________________________________
Address: _________________________________________
_________________________________________
_________________________________________
Phone Number: ____________________________________
Email Address: ____________________________________
Arrival Date: _________________
Departure Date: _______________
Reservation Information: Any questions or concerns can be addressed by emailing us at Scottkiloby@aol.com
Place an X by the appropriate line.
One Person Full Weekend $160_________
Two People Full Weekend $280_________
One Person Private Room/Full Weekend $246__________
One Person Retreat Only (no lodging) $80__________
Two People Retreat Only (no lodging) $160_________
Method of Payment: Check__________ Money Order_______
I am willing to share a room Yes______ No______
I would like to share room with:_____________________________________
Special Needs -- Please note here if you have any special needs or requests, such as a first floor room, food allergies, __________________________________________________________________________________________________________________________________________________________________________________________________
REGISTRATION FORM
KILOBY RETREAT MAY 1ST-3RD 2009
FOR USE BY THE KILOBY FOUNDATION ONLY
Registration Received________________
Confirmation Sent___________________
Refund: Yes_________ No__________
Refund Sent__________
Cancelled_________________________