Lakeshore Retreat Millersylvania State Park, Washington October 15,16, and 17 2010 MAIL: P.O. Box 112096, Tacoma, WA 98411-2096 PHONE: (253)279-7816 EMAIL:lkshoreretreat@aol.com TO REGISTER: * Print the form below, complete it, and snail-mail to the address above. * Please write clearly and complete a form for each registrant. * Include your check/money order for $70. * Make check/money order payable to Lakeshore Retreat. * Partial scholarships are available on a limited basis.   Email us for more information. Deadline October 4, 2010 Your $70 registration fee includes: * Five meals (Friday dinner, Saturday breakfast, lunch and dinner and Sunday breakfast) * Lodging accommodations in 8-person bunkhouses * All workshops, speaker meetings and planned activities **************************************** Name__________________________________________ Address_________________________________________ City____________________State/Prov._____________ Country___________Zip/Postal Code_______________ ____ I require wheelchair access or have limited mobility. ____ I have other special needs (please list). Daytime Phone___________________________________ Evening phone___________________________________ E-mail__________________________________________ Fellowship: (circle one) AA Al-Anon Recovery Date (optional)________________________ Your name as you want it to appear on your badge: We will make every attempt to accommodate groups who wish to share cabins. To facilitate this, please list the names of people you are traveling with; last names will be helpful to avoid confusion. If possible, send in your registrations together. Name____________________________________________ Name____________________________________________ Name____________________________________________ Name____________________________________________ $ MY PAYMENT ____ DONATION TO FUND SCHOLARSHIPS ____TOTAL ENCLOSED **************************************** We will acknowledge (by email if possible) receipt of registrations received by the deadline of September 11,2009 Your confirmation will include further information and suggestions to make this retreat a success for you. DIRECTION: From I-5, take exit 95 (Littlerock/Maytown/Hwy 121 N). Turn east onto Maytown Rd SW/Hwy 121 N. Drive 3.1 miles (at the “T” intersection, Hwy 121 N turns left, becoming Tilley Rd S.) Turn left (west) into the park entrance.