Please copy and paste this form to an e-mail or word doc
and e-mail it to
Eana at
eana@nalinilomi.com . You can also print it out and snail mail
a check to
Eana Rose PO Box 510, Kilauea, HI 96754 or make a payment via paypal
using the link at the bottom of the page
Payment options at the bottom of this page
Retreat Name & Location______________________________________________
Retreat dates_______________________________________________________
Your name_________________________________________________________
Address____________________________________________________________
e-mail______________________________________________________________
phone______________________________________________________________
deposit _____________________________________________________________
Entire retreat tuition____________________________________________________
check#________________MO____________
send to: Eana Rose PO Box 510 Kilauea, HI 96754
PayPal payment option this page________________ please indicate here the date you make your PayPal payment
Mahalo & Aloha
accommodations options_________________________________________________________________