Your name:
Your address:
Your phone number:
Your email address:
Referred By:
How did you hear about
Crop till you drop Retreats?
(friend, magazine, website)
Pricing:
Registration - $45

(A portion of the proceeds to benefit the Junior
Diabetes Research Foundation International in
connection with Strike out Diabetes)
Payment Options:
Pay in full
Payment Method:
Choose from below
Paypal (After registering, return
to "Make a Payment" Page

Check (Made payable to Crop till
you drop Retreats)
Deposit &
Cancellation:
For this event, your deposit needs to be
the entire registration cost (i.e. $45) A
portion of the proceeds to benefit the
Junior Diabetes Research Foundation
International in connection with Strike out
Diabetes and therefore no refunds will be
issued.
Comments:
Crop till you drop Retreats
Crop out Juvenile Diabetes Fundraiser Day Crop
November 8, 2009
9am - 8pm
Hyatt Summerfield Suites
2611 Contra Costa Blvd.
Pleasant Hill, CA