Puma Registration Form

Awakening the Puma:
An Introduction to Inka Mysticism

as lead by Valerie Niestrath

At EarthTeach Forest Park, Ashland Oregon

June 9 & 10, 2007

Registration Form

Name:____________________

Address:__________________

City, State, Zip:____________

Phone:___________________

Email:___________________

Please download EarthTeach Park Waivers & Liability Release Forms at the EarthTeach website page:
http://www.earthteach.org/page20/page20.html

Enclosed is my check for $250* made payable to The Way Foundation

*A tax-deductible portion of this tuition will be donated to EarthTeach Forest Park by The Way Foundation, a 501(c)3 non-profit organization.

Return signed waivers and check to:
EarthTeach Forest Park
76 Dewey Street
Ashland, OR 97520