Registration

A Compassionate Journey to Berlin, Germany  May 8-15, 2007

with Brian and Lisa Berman

A Compassionate Listening Delegation

Please print & carefully fill out the following form, then mail with your deposit to:

The Compassionate Listening Project
P.O. Box 17, Indianola, WA 98342    USA
phone: (360) 297-2280, fax: (360) 297-6563
email: office@compassionatelistening.org

Name:

Address:

City:                                                                            State/Country:                                Zip:

Telephone - Day:                                                Telephone - Evening:

Email:

Age:                                                                            Country of Citizenship:                                

Occupation (optional):                                             Gender: M______  F______                   

Religious affiliation/practice (optional):                

Languages spoken:

What draws you to participate in this delegation? (use the back if you need more room)

What do you hope to get from participating in this delegation?

Participants are expected to have good communication skills and a commitment to conflict resolution. What are your strengths in this area?

How did you learn about this delegation?

Reservations: Your $300 deposit will secure your spot on this trip, space is limited.

Payment: The cost for the delegation to Berlin is $1,695* or $1,595* if registered by January 15, 2006. This price is based on an exchange rate 1EUR = 1.25 USD. (*The final price will be based on the exchange rate as of April 1, 2007) Airfare is additional and purchased separately. We accept payment by check and credit card. Full trip payment is expected 60 days before the trip unless other arrangements are made with The Compassionate Listening Project.

For more information please contact Brian and Lisa Berman at info@BermanHealingArts.com or call 360-297-3358.

This project offers the possibility of deep healing and the facilitators provide a safe, supportive environment. You will hear personal stories that might bring up a full range of emotions. As a participant you are agreeing to take full responsibility for your health and well-being throughout the delegation.

_____________________________________                        __________________

Signature                                                                                                          Date

_____________________________________                        __________________

Emergency Contact (Relation)                                                                Phone

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