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Sophia Summer Institute 2010 & Post-Institution Retreat Registration Form

PLEASE PRINT
NAME:_________________________________________________ PHONE #_________________________________

ADDRESS:_______________________________________________________________________________________

CITY/STATE/ZIP:__________________________________________________________________________________

EMAIL |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
INTERACTIVE DIALOGUE
Select One for Friday and One for Saturday

#1 Jean & Larry Edwards “Growing Evolutionary Food: Stardust to Supper"

___ Friday ___ Saturday

#2. Carl Anthony & Paloma Paval “Navigating deep time and metropolitan space: a compass for transformative leadership, sustainability and social change in the 21st century”

___ Friday ___ Saturday
 #3. Osprey Orielle Lake  “Two Aspects of Thomas Berry's Fourfold Way: The Knowledge of Women and Indigenous Peoples in a time of Transition” 

___ Friday ___ Saturday

___ Summer Institute Tuition $300.
Summer Institute meals and accommodations on HNU campus. (4 days, 3 nights):
___ Single Room $300.
___ Double Room $255.

___ Post-Institute Retreat Tuition $200.
Post-Institute Retreat meals and accommodations on HNU campus. (3 days, 2 nights):
___ Single Room $200.
___ Double Room $170.

Total amount enclosed: $______________

NOTE: I am taking the
___ Summer Institute 2010 for Academic Credit ___ Post Institute Retreat for Academic Credit

Total amount enclosed: ............................$________
Refunds for tuition and housing can be made (less $25 administrative fee)
if written notice of cancellation is received by JULY 3, 2010.

PAYMENT METHOD: __Check (to Sophia Center) __ Money Order (to Sophia Center) __ MasterCard __ Visa

Credit/Debit Card Number: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Validation Number :|___|___|___| Exp. Date: Month|___|___| Year|___|___|
(Validation Number - Three-digit number on back of credit card. )

Cardholder's name as printed on Credit Card. (Print)____________________________________________________________________________________
Send Credit Card Payment: by fax: 1-510-436-1338. (Please do not email your credit card information.)
by mail: The Sophia Center, 3500 Mountain Blvd., Oakland, CA 94619-1699

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