PROGRAM REGISTRATION FORM

Please print this form, fill it out and mail with a check to:

Ruah Spirituality Institute
1773 Beacon St
Brookline MA 02445

Please make checks payable to: Ruah Spirituality Institute, Inc.

Name:_______________________________________________________

Organization:_______________________________________________________

Address:______________________________________________________

____________________________________________________________

City:______________________ State: ___ ZIP Code: _________

Phone #:_____________ (home) ______________ (work)

E-mail:__________________________

Please register me for the following programs:

____________________________________________________________

____________________________________________________________

____________________________________________________________

Amount Enclosed: $__________________________

For more information on programs, please call 617-277-0036 or e-mail ruahspirit@gmail.com.

For information on scholarship assistance or payment plans, please contact
Myriah Klein, Ruah Registrar, at 617-277-0036.