Please print, complete form below, and mail to us at

BEhawaii

PO Box 2148

Pearl City, HI 96782

OR  e-mail to:  Info@BEhawaii.info

For Registration and Reservation for our October 10. 11 and 12, 2008 Healing Weekend

Questions? Phone - Linda at 294-8571  or Arlene at 949-3387   

BEGINNING EXPERIENCE WEEKEND REGISTRATION  

Date________________

Email Address __________________________

Name ________________________________________________________________ M  F 

Address ______________________________________________________________________

City ______________________________________________ Zip Code ___________________

Phone ____________________ Cell _____________________ Work _____________________

Age ______ Religious Affiliation ____________________________ Number of Children_______

Years Married __________ Divorced _________ Widowed__________ Separated __________

How did you hear about Beginning Experience of Hawaii? _______________________________

_____________________________________________________________________________

Have you ever participated in a divorced, separated or widowed support group? Yes  No 

Comments ____________________________________________________________________

What do you hope to gain from this Weekend?

_____________________________________________________________________________________________________________________

Do you have any physical limitations such as climbing stairs, hearing, etc we should know about? _____________________________________________________________________________

Cost of Weekend $200. Includes 5 meals, tuition & 2 night accommodations. No hidden costs.

(Refundable deposit of $ 100 for guaranteed reservations)

Make check payable to BEGINNING EXPERIENCE OF HAWAII and mail to

BE Hawaii, PO Box 2148, PEARL CITY HI 96782