Retreat Title: Contact Improv in Paradise
Dates: February 22-28, 2009

Your Name:________________________________ Your Email:____________________

Your Home Address:_______________________________________________________

Phone # (hm)___________________________Phone # (cell)_______________________

How did you hear about this retreat?_________________________________________________

Have you attended any of Moti's workshops before?_______________________

About you (use back of page, if necessary):
____ I have these special dietary needs: _______________________________________
____ I am in excellent health & physical condition.
(If not, please describe your condition on a separate sheet, and your medication.)

Languages you speak:______________________________________________________

Your Age:__________

In case of emergency, contact (include daytime & evening phone numbers):

_________________________________________________________________________

Occupation &/or vocational passion/dream:

Contact Improvisation Experience:

Dance/Movement Experience:

What do you hope to receive/experience from this retreat:

* Minimum of $100 deposit to save space, remainder due by January 1, 2009

Deposit can be paid by clicking HERE online / or sent to the address below

I have enclosed/sent/or paid online the following payment:

$______ deposit

$______ in full payment