Eupsychia Institute

PO Box 151960

Austin, TX 78715-1960

(800) 546-2795

(512) 327-2795

Fax (512) 327-6043

Email Eupsychia

Eupsychia Home

 

You can also register by phone:
800.546.2795

Brenda in the Eupsychia office will be happy to take your information.

 

Cancellation Policy: If you must cancel, please do so by midnight of JULY 10, 2005 in order to receive your partial deposit back. A $50 administration fee will be deducted for all cancellations on or before this date. No deposit refunds will be given after midnight of July 10th. Because we become financially liable to the retreat center for cancellations after this date we cannot make exceptions about returning deposits. We appreciate your understanding.
Name (First and Last):
(If you are paying for more than one person, please fill out a separate form for each attendee. Thanks!)
Mailing Address:
(include apartment numbers or suite numbers)
City: State:
Zip/PostalCode: Country:
Home Telephone (w/ area code):
Cell Phone Number:
Work Telephone (w/ area code):
Email Address:
IMPORTANT!
Dietary Choice:

Special Dietary Information (we will accomodate special diet within reason) :

ROOMING (check one):

Double Occupancy OK

Roommate Name (if known):

Single Room ($350 extra)

(availability on limited basis)
SMOKER: No Yes

TRAVEL: Flying Driving

If taking the shuttle, we need your travel itinerary in detail when known. Please call, fax or email your information.
SHUTTLE: Yes No
Payment Method:
Authorized Amount:
Credit Card Number: Expiration Date:
Security Code on Back of Card:
Does your credit card statement mail to the address supplied above?
Yes No .

If no, please supply statement billing address:

How did you learn about Eupsychia?

If you did an internet search, what keyword did you use, if you remember?

ADDITIONAL COMMENTS OR YOUR FLIGHT INFORMATION (if known):
(Airline Carrier, Departure City, Flight Numbers, Connecting City and Flight Number, and Departure time on August 18th):

Do you need a response to your comment?

(If yes, please make sure you give us your email address and phone number in the appropriate fields above.)
By pressing the "send" button, you are authorizing Eupsychia, Inc. to charge your Credit Card the amount you have indicated above...

 

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THANKS!
WE LOOK FORWARD TO BEING WITH YOU THIS SUMMER!

 
© 2005 Eupsychia Institute, Inc. All rights reserved.