Name______________________________________________________
Address______________________________________________________
City_________________________________ State___________ Zip__________________
Phone__________________________ Email_______________________________
Title of Workshop_____________________________________________________
Choice of Lodging:
Please indicate your preference when registering.
Commuting______
Private (limited space)_________
Dormitory-style______
Tenting/Camping______
Tipi______
Amount of Payment Enclosed _______________
Make Payments to "Shamanic Visions".
Enclose check with Registration Form and Mail to:
Pirkko Miller
P.O. Box 193
North Webster, Indiana 46555