828-693-9292
Fax 828-693-1919
PO Box 1793
Flat Rock, NC 28731

Spiritual Direction &
Dream Leader Training
in the Jungian Mystical Christian Tradition

Summer Dream Conference
Application

You are beginning the application process for the Summer Dream Conference.

Check-in 4-6pm Sunday, ends with breakfast Friday

Required fields are marked with an asterisk (*).

Conference Information

Please indicate the year for which you are applying.

Year*:

Personal Information

Last Name*:

First Name*:

Middle Name:

Preferred name/Nickname:

Title: Suffix:

Male * Female *

Address*:

Address 2nd line:

City*: State*:

Zip*: Country*:

Please include your area code and separate your entry with dashes (e.g. 123-456-7890)

Home Phone*:

Cell Phone:

Work Phone:

Other Phone:

Fax:

Email Address*:

Retype Email*:

Spouse's Name:

Dream Experience *

Attended a dream group 3 or less times *
Attended a dream group 4 or more times *

Emergency Contact Information

Please list someone who will NOT be with you.

Full Name *:

Relationship *:

Phone #1 *

Phone #2

List any health issues:

Religious Information *

Religious Affiliation *:

Please select one of the following *:
Layperson
Member of Religious Order
Deacon
Priest/Minister

Room - OR - Commuter Request Room at Kanuga
Commute to Kanuga

Room Request

Lodging Preference (includes all meals) *:
Cottage
Guest House
Inn

Room Selection *:

Double

Roommate Request:

Single (If Available)

Commuter Request

Commuter Meal Preference *:

With lunch and supper
With all meals

Companion Information

Number of people for whom I am paying *:

Names of people coming with me and

ages of children:

Notes:

In applying, please note any medical needs such as diet or handicap accommodations. Unless otherwise informed, Kanuga will consider your application as permission to use photographs, audio/video recording of you for Kanuga promotion, its website or new media coverage. Committed to the principles of equal opportunity, The Haden Institute makes its programs available without regard to race, creed, religion, sex, disability, age or national origin.

Payment

There is a $50 Application Fee per person (non-refundable).

Online Credit Card Payment through PayPal

(VISA/MasterCard/American Express/Discover)

Check - Mail to:

The Haden Institute
PO Box 1793
Flat Rock, NC 28731

Phone In Credit Card (VISA/MasterCard)

828/ 693-9292