Wisdom House Registration Form 229 East Litchfield Road Litchfield, CT 06759
Office: 860-567-3163 Fax: 860-567-3166
Program Title: ___________________________________________________________________________
Program Date: ___________________________________________________________________________
Please print this registration form, include payment where applicable, and mail to Wisdom House.
Registrations can only be confirmed after receipt of application with a check for full payment.
Confirmation also depends on the 'availability' of your selected accommodation. Please choose
only an accommodation listed in the details of the program.
Shared Room/Hall bath
Private or Shared Room w/Bath (limited, give second choice)
Special Dietary Restrictions: (Please check one for yourself and friend, if applicable)
___Vegetarian (No meat or fish)
___ Lactose Intolerance
Full payment enclosed _____________________________