Wild Dolphin Swim Retreat Registration Form August 12-18, 2007 OR August 19-25, 2007 Questions? Please call 520-320-6366. To return to Wild Dolphin Swim Retreat, click here. After completing this form, print page, sign where indicated, and mail with your check or money order (USA funds only) to: Dr. Damaris Drewry P O Box 64682 Tucson, AZ 85728. For those that prefer to pay by credit card, click here. A completed form must still be mailed. CANCELLATION POLICY Cancellations more than 45 days prior to the retreat - $100 fee Cancellations 45-30 days prior - $200 fee Cancellations less than 30 days: no refund unless your spot is filled ($200 fee if it is filled) Please complete all boxes, print and add signature before mailing. First Name MI Last Name Address: Street City State Zip Code Daytime telephone number Email address Which week will you attend? August 12-18: August 19-25: If you are a couple and would like a private room, please call to make arrangements: (520) 320-6366 Any allergies to food? Food preference: Vegetarian Non-vegetarian Any other allergies/preferences? What would you like to experience at this retreat? Please rate your swimming confidence on a scale from 1 to 10 (1 meaning you don't know how to swim, and 10 being life-guard certified): I rate myself a Would you prefer to rent a kayak? (Yes/No) WAIVER OF RESPONSIBILITY I, _____________________________, agree to take responsibility for my own health, well-being and physical safety during the Wild Dolphin Swim Retreat facilitated and created by Damaris Drewry, Ph.D. I therefore release her from any liability should I experience any physical injury or emotional discomfort at THE DOLPHIN HOUSE, or if I am accepting transportation to and from the airport arranged by Dr. Drewry.