Women's Escape Weekend

Registration Form

Women's Retreat Date: ____________________

Name:     ________________________________

Address: ________________________________

               ________________________________

Postal Code: ______________________________

Day Phone No: ____________________________

Evening Phone No: _________________________

Email Address: ____________________________

Please fill out and mail, email or fax:

YoWoChAs Outdoor Education Centre

Box 313

Fallis , AB T0E 0V0

Phone: (780) 892-2660

Fax: (780) 892-2888

Email: yowochas@ywcaofedmonton.org

Women's Retreat Cost: $170.00 (GST included)

You can pay by cheque, Visa, or MasterCard.

Cheques payable to YWCA of Edmonton

Card No: _______________________

Exp. Date: ____________