Mount
Shasta, California
July 3rd, 2008
Thursday, 10:00 AM - 2:30 PM
TUITION: $67-100 (flexible fee scale)
MORE
INFORMATION: Call Beth Beurkens
(541) 708-0473
TO
REGISTER: Please
send full fee with the completed information
below to:
Beth Beurkens, PO Box
483, Ashland, OR 97520
Enclosed is: $_____________($67.-$100 full fee)(nonrefundable) for Writing on Lake Siskiyou
Name_____________________________________
Address______________________________email________________________
City_____________________
State_____ Zip__________
Phone_________________________
Liability Release Form
Date_____________________________
I will not hold Beth Beurkens legally responsible for any injury, illness, accident, or other misfortune that may occur in connection with my participation in the Writing On Lake Siskiyou workshop on
Thursday, July 3rd, 2008 on Lake Siskiyou, California.
Signature____________________________________________________________
Printed Name_________________________________________________________
(PLEASE SEND VIA US MAIL. DO NOT EMAIL)
Please mail with your check to: Beth Beurkens, PO Box 483, Ashland, OR 97520
When I receive your registration, I will send you a confirmation letter with directions and all other
relevant information.
Questions? You can reach me at (541) 708-0473: or email me at beth@shamanicuniverse.com
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Writing on Lake Siskiyou