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:
$60 One Day
$100 Two Days
(Rate includes lunch and all day beverage service.
Rate does not include a hotel room, if you are
interested in staying over at the hotel, we will have a
group rate available closer to the event)
Day Option:
One or Two Days

Which Day?
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:
Fundraiser fees are non refundable.
Comments:
Crop till you drop Retreats
Juvenile Diabetes Fundraiser
November 6-7, 2010
Hyatt Summerfield Suites
Pleasant Hill, CA