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John Gray's

Mars Venus Wellness Retreat

Registration Form

Name:(first)________________________(last)_____________________________

Address: _____________________________________________________________

City: __________________________State: ____________Zip: _________________

Phone: (day)________________________  (evening)_________________________

E-mail: ____________________________ Fax: _____________________________

Date of Wellness Retreat: _______________

Weekend Retreat:

Number of reservations: _______  X  $__________ per person = ________________

Five-Day Retreat:

Number of reservations: _______  X  $__________ per person = ________________

Name(s) of additional person(s):  _________________________________________

Method of payment:

(   )    Check or money order $____________ (US Currency only)

          Made payable to:   Mars Venus Wellness Retreat

(   )    VISA    (    )    MasterCard                                              $_______________

Card #:_____________________________________Exp:______ 3 digit SC:______

Signature required:_____________________________________________________

I understand that the fees do not include: Air Transportation, Ground Transportation from Airport/Hotel or accommodations.  Refund request must be made in writing and received at least 7 business days prior to the event. Refunds less cancellation fees will be made within 15 days of receipt of your written notice of cancellation. 

Mail form to:

Mars Venus Wellness Retreat, 20 Sunnyside Avenue, Ste A130, Mill Valley CA 94941

Or FAX form to:  (480) 969-1404    

To register by phone: 877-JohnGray (877-564-6472)