Please first print this page and then fill out and mail to the address provided below.

Registration Form


Name:___________________________________________________


Address _________________________________________________


City_______________________________________

State________________ZipCode_____________


Telephone__________________________________

E-mail______________________________________________


Fax_______________________________________


Name of Program You are Registering For:

[ ] Bear Medicine Program    [ ] Medicine Wheel

Commitment

I understand and accept that:

  • I am responsible for showing up for each week-end, physically and otherwise.
  • I am responsible for fulfillment of the financial obligations of this program including tuition fees and all personal expenses, including supply and equipment purchases and travel expenses.
  • I am responsible for acquiring and bringing the necessary supplies and equipment for each week-end.
  • I am responsible for taking care of myself as an active member of the community.
Financial Responsibility

Bear Medicine Program
[ ]   I’ve enclosed the $200, non-refundable application fee. If the full amount is paid by May 15th of the program year, there is a $200 discount, so that the program cost will be $1600. In addition, there is a $300 charge for materials that include a bear skin and other materials that you will make your own to take home with you.

Medicine Wheel for Men or Women
[ ]   I’ve enclosed the $200, non-refundable application fee. The fee for the Medicine Wheel program is $2100. This includes food and housing for all four weekends. If the full amount is paid by January 15th of the program year, there is a $300 discount, so that the program cost will be $1800.

Payment Plan
[ ]    I am interested in a payment plan. I will contact the program to make arrangements. No discounts are applicable for payment plans.

No refunds are rendered for cancellation within one month prior to the start of the program you are registering for.

 

________________________________________________
Signature

Date

Mail Application and Payments 


One White Horse Standing
c/o Herb Stevenson
9796 Cedar Road
Novelty, Ohio 44072-9747

E-mail Herb

 


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