Women’s Lakota Pilgrimage Registration Form – August 5-12, 2006

Please return this registration form with a deposit of $100 to:

Borderlands Education and Spiritual Center
23120 South Rochford Road Hill City, SD 57745

_____I wish to register for the Women’s Lakota Pilgrimage Experience. Enclosed is a
check or money order for $100 as a deposit for tuition.
_____I wish to apply for $_____ scholarship assistance.
_____I want shared lodging at the ranch.
_____I will lodge elsewhere.
_____I want to camp.

We will try to have fresh, wholesome food available that will please everyone for our community meals. Please let us know about your dietary requirements: (diabetic, vegetarian, etc.) List some things that you can't live without for your meals (i.e. Earl Grey tea, decaf coffee, daily apples) or a strong preference for a particular food item.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name____________________________________________________________
Mailing Address_______________________________________________________
City________________________State_________Zip______________
Telephone:Day_______________________Evening_______________________
Email____________________________________________________________
I plan to arrive at the ranch by ______________am/pm on Sunday,
August 5. (The ranch is approx. one hour from the airport.)
Comments:___________________________________________________________________________________________________________________________________________________________________________________