Registration Form & Mailing Instructions

June 9-11, 2017
The Healer's Challenge: Treating Cancer

To apply for this weekend workshop, submit your completed registration form and your payment-in-full.

What to Bring:

A journal or notebook for notetaking, pen or pencil, and colored pencils (latter is optional). Beverage service (coffee, tea, water) will be provided throughout the workshop. Attendees are on their own for all snacks and meals. There are numerous restaurants within easy walking distance of the Hilton - a list and map will be provided at the workshop.

Registration Form





Home Phone__________________________________________

Cell phone__________________________________________


Name for ID Tag______________________________________

Emergency Contact Name__________________________________

Emergency Contact Phone #__________________________________

$25 Friday evening lecture only
$315 Early Bird Fee (if paid in full by Friday, May 12. Includes Friday Evening Lecture)
$345 Regular Fee (You must pre-register to insure space. Includes Friday Evening Lecture)

Check # ______ payable to Kathy Miritello and/or

MC Visa Disc AMEX
CC#_________________________________Ex. Date________ CVV/CID#_____)

Registration Information

Please mail the completed registration form below and payment to:

Kathy Miritello
304 Wesley Dr
Asheville, NC 28803-2052

Prefer email? You may also print and scan the completed form and send to Kathy Miritello at but please do not include credit card information via e-mail as it is not secure. Instead, call me with your credit card information at 828-545-7646.

Questions? Please feel free to phone Kathy at (828) 545-7646.