Lakota Benedictine Experience Registration Form - June 14 – 19, 2009

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 Lakota Benedictine 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.


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.
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Name_______________________________________________________________

Mailing
Address_______________________________________________________

City________________________State_________Zip______________

Telephone
Day_______________________Evening_________________________

Email______________________________________________________________

I plan to arrive at the ranch by ______________am/pm on Sunday,
June 14. (The ranch is approx. one hour from the airport.)


Comments:__________________________________________________________
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