REGISTRATION FORM

Song of the Goddess, Grail & Gypsy
Pilgrimage in Southern France
May 16 - 26, 2010

Welcome to our Song of the Goddess, Grail & Gypsy Pilgrimage in Southern France, May 16 - 26, 2010.
Please fill out the following information and sign and return as soon as possible. Acceptance of all conditions of the Tour Responsibility Waiver and the two Tour Logistics Pages is confirmed by your dated signature on this form.

Name as it appears on passport_______________________________________________

Name you wish to be called___________________________________________________

Mailing address____________________________________________________________

Home phone_________________________Work phone____________________________

Email______________________________ Website_______________________________

Occupation_______________________________ address__________________________

Birth date (month, day, year)_______________Birth time and place__________________

Passport number__________________Date and place of issue______________________

In case of emergency notify __________________________________________________

Phone_________________________________Relationship_________________________

Special dietary and health needs_______________________________________________

_________________________________________________________________________

Roommate preference_______________________________________________________

(Single Supplement when available is $600.00)

**I have read the Tour Logistics/Tour Responsibility pages and agree to the conditions:

Signed__________________________________________

Date____________________________________________

**Please make payments to: Ani Williams and mail with registration form to:
Ani Williams, 2675 W. Hwy 89A, #1081, Sedona, AZ 86336 or Fax: 928-282-5870.
We are looking forward to your presence in Southern France for the Song of the Goddess, Grail & Gypsy Pilgrimage, May 16 - 26, 2010.
May many blessings and good fortune come your way! Ani